Celena Nicole Shivers, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5017424 Issued in NC

Practice address

10430 Harris Oak Blvd Ste L
Charlotte, NC 28269-7513

Phone

(704) 317-2930

Fax

(704) 644-2513

NPI assigned

Nov 16, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other names 1

• Celena Nicole Upchurch Former name

Medicare fee-for-service enrollment

Enrolled in NC, SC, OR3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Greater Alliance Behavioral Health

  • Psychiatric/Mental Health Registered Nurse
  • Indian Land, SC
  • NPI 1639851132

  NC

  Medicare reassignment NPD Authorized official
• Clinicops, LLC

  • Family Medicine Physician
  • Portland, OR
  • NPI 1275821266

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Clinicops LLC

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1912431594

  Psychiatric/Mental Health

  NPD

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

{
    "created_epoch": "1668556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1033828207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6037 LANDRY LN",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297076060",
            "telephone_number": "803-979-6171",
            "fax_number": "704-817-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10430 HARRIS OAK BLVD STE L",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282697513",
            "telephone_number": "704-317-2930",
            "fax_number": "704-644-2513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6037 Landry Ln",
            "address_purpose": "LOCATION",
            "city": "Indian Land",
            "state": "SC",
            "postal_code": "297076060",
            "country_code": "US",
            "telephone_number": "803-979-6171",
            "fax_number": "704-817-1470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIVERS",
        "first_name": "CELENA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-16",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10011737",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "294831",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5017424",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "SC",
            "license": "205549",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CELENA",
            "last_name": "UPCHURCH",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph Shirley, DDSN
• Sergei Shirman, D.M.D.
• Hitesh Shivalingappa, M.D.
• Ravina Anne Shive, LMFT
• Carroll Paul Shivers Jr., MD
• Edwin H Shoaf, M.D.
• Kayla Tracy Shoaff, RBT
• Tope Shobowale
• Joshua K Shoemake, MD
• Laura Beth Shofe, CRNA

• Psychiatric/Mental Health Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.