NPIMap

Individual provider Active NPI

Tucker A Sheley, APRN,CNP

  • Family Nurse Practitioner
  • Pine River, MN
National Provider Identifier
1023626918
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7543 Issued in MN
Practice address
415 Barclay Ave
Pine River, MN 56474-1603
Phone
(218) 587-4416
NPI assigned
Jul 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7543 MN Primary

Addresses

Primary practice location

415 Barclay Ave
Pine River, MN 56474-1603

Mailing address

1702 University Dr S
Fargo, ND 58103-4940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201111001330 MN Practitioner - Nurse Practitioner 2062822570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

280 Barclay Ave W
Pine River, MN 56474-5197
Phone (218) 587-4416

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-7394

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7543MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Medical Center CurrentSince Aug 31, 2020 Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
St Joseph's Medical Center CurrentSince Aug 31, 2020 Accepting new patients
St. Joseph's Medical Center Past Accepting new patients

Locations

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

280 Barclay Ave W
Pine River, MN 56474
Phone (218) 587-3222

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1023626918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 BARCLAY AVE",
            "city": "PINE RIVER",
            "state": "MN",
            "postal_code": "564741603",
            "telephone_number": "218-587-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELEY",
        "first_name": "TUCKER",
        "middle_name": "A",
        "credential": "APRN,CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "7543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine River, MN

Sources for this page

Verify at the official NPI Registry.