Shada Breeze Tennyson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

903537 Issued in MS

Practice address

1018 N Gloster St
Tupelo, MS 38804-1297

Phone

(662) 523-4950

Fax

(662) 890-5746

NPI assigned

Oct 7, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Quality Healthcare Resources LLC

  • Family Nurse Practitioner
  • Little Rock, AR
  • NPI 1205081437

  MS

  Medicare reassignment NPD
• Spring Valley Hospice, LLC

  • Community Based Hospice Care Agency
  • Olive Branch, MS
  • NPI 1306086756
  NPD (past)

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1043851587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 N GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388041297",
            "telephone_number": "662-523-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 N GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388041297",
            "telephone_number": "662-523-4950",
            "fax_number": "662-890-5746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENNYSON",
        "first_name": "SHADA",
        "middle_name": "BREEZE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-07",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Max Taylor, MD
• Nicole Sherice Taylor, NP
• Pami Jo Taylor, M.D.
• Riley Taylor
• Jackson Teer, DO
• Rhonda Lashoun Terrell, LCSW
• Jennifer Terry, RN
• Raelynne Putman Terry, FNP
• Pamela Lynn Tharp
• The Chadwick Clinic LLC

• Family Nurse Practitioner in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.