Martha Jean Shaw
Individual provider Active NPI Licensed Practical Nurse · Taylor, MS
NPI 1003967217 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1003967217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 164W00000X (MS)
- Practice address
- 188 County Road 343
Taylor, MS 38673-4541 - Phone
- (662) 236-4543
- NPI assigned
- Jan 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164W00000X | MS | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 164W00000X | MS | Yes |
Addresses
Primary practice location
188 County Road 343
Taylor, MS 38673-4541
Mailing address
188 County Road 343
Taylor, MS 38673-4541
Phone (662) 236-4543
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00770204 | Medicaid | MS |
Other providers in Taylor, MS
- Dr Elizabeth M Darby Optometrist PLLC
- Felisa R McKnight
- Ms Eye Care PA
- Yusha Pattonbey
- Kenya Person
- Orianna Shaw
- Kara Desiree Tidwell
All providers in Taylor, MS · Licensed Practical Nurse in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.