Karen B. Shackelford, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

14931 Issued in MS

Practice address

305A Keyway Dr
Suite a
Flowood, MS 39232-9572

Phone

(601) 936-3663

Fax

(601) 362-9806

NPI assigned

Jul 23, 2007

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

Other names 1

• Karen Elizabeth Bergstrom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• United Emergency Services, Inc.

  • Emergency Medicine Physician
  • Booneville, MS
  • NPI 1326007915
  NPD (past)
• Vicksburg Healthcare LLC

  • Anesthesiology Physician
  • Vicksburg, MS
  • NPI 1629084058

  Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185148800000",
    "number": "1073713491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305A KEYWAY DR",
            "address_2": "SUITE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329572",
            "telephone_number": "601-936-3663",
            "fax_number": "601-362-9806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305A KEYWAY DR",
            "address_2": "SUITE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329572",
            "telephone_number": "601-936-3663",
            "fax_number": "601-362-9806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "KAREN",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-23",
        "last_updated": "2007-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "14931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAREN",
            "last_name": "BERGSTROM",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Callie Hall Self, AGNP
• Rachel M Sellers, PA-C
• Sessoms Therapeutic Counseling and Consulting Services, LLC
• Shonda Monique Sessoms, LPC
• Tatum Lee Severino I, DNP, FNP-C
• Lillian Leigh Shank, FNP-BC
• Selina Shanks
• Angela B. Shannon, M.D.
• Ramin Shariati, MD
• Anna Clair Sharp, PMHNP-BC

• Emergency Medicine Physician in Flowood, MS
• Providers in Flowood, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.