Active NPI
Shelby Angela Crandall, EMT
- Basic Emergency Medical Technician
- Ennis, MT
National Provider Identifier
1003439985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Basic Emergency Medical Technician
- License
- 58590
- Practice address
- 11 Two Springs Rd
Ennis, MT 59729-9188 - Phone
- (406) 210-5629
- NPI assigned
- May 26, 2020
- Last updated
- May 26, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | 58590 | MT | Primary |
Addresses
Primary practice location
11 Two Springs Rd
Ennis, MT 59729-9188
Mailing address
11 Two Springs Rd
Ennis, MT 59729-9188
Other practice location 1
Kayenta Health Center
Hwy 160 M.P. 394.3
Kayenta, AZ 86033
Phone (406) 210-5629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58590 | MT | MD | Basic Emergency Medical Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590451200000",
"number": "1003439985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 TWO SPRINGS RD",
"city": "ENNIS",
"state": "MT",
"postal_code": "597299188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 TWO SPRINGS RD",
"city": "ENNIS",
"state": "MT",
"postal_code": "597299188",
"telephone_number": "406-210-5629"
}
],
"practiceLocations": [
{
"address_1": "Kayenta Health Center",
"address_2": "HWY 160 M.P. 394.3",
"address_purpose": "LOCATION",
"city": "Kayenta",
"state": "AZ",
"postal_code": "86033",
"country_code": "US",
"telephone_number": "406-210-5629",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CRANDALL",
"first_name": "SHELBY",
"middle_name": "ANGELA",
"credential": "EMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-26",
"last_updated": "2020-05-26",
"certification_date": "2020-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "MT",
"license": "58590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ennis, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.