Jordan Frazier Shelburne, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

28750 Issued in TN

Practice address

2410 Susannah St
Johnson City, TN 37601-1748

Phone

(423) 282-9011

NPI assigned

Jan 7, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dominion Health and Fitness, IncGroup PAC ID 3274570908, 71 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

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.

• Watauga Orthopaedics PLC

  • Orthopaedic Surgery Physician
  • Johnson City, TN
  • NPI 1245251404

  Family

  Medicare reassignment NPD
• Dominion Health & Fitness, Inc

  • Physical Therapist
  • Clintwood, VA
  • NPI 1871513788
  Care Compare group
• Watauga Orthopaedics, PLC

  • Durable Medical Equipment & Medical Supplies
  • Greeneville, TN
  • NPI 1730924192
  NPD

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1083202725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 ANCHOR PT",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376642986",
            "telephone_number": "276-337-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011748",
            "telephone_number": "423-282-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "340 Steeles Rd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376209532",
            "country_code": "US",
            "telephone_number": "423-282-9011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "875 Larry Neil Way",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376606368",
            "country_code": "US",
            "telephone_number": "423-282-9011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4213 Anchor Pt",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376642986",
            "country_code": "US",
            "telephone_number": "276-337-0478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHELBURNE",
        "first_name": "JORDAN",
        "middle_name": "FRAZIER",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-07",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "28750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "28750",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah L Sheffey, MA, LSPE
• James Emerson Sheffey, MD
• Kim Leigh Sheffey, CRNA
• Makayla Rae Sheffield
• Nazia Iqbal Shehzad, MD
• Daniel J Shelby, DMD
• Cheryl Shelnutt
• Amy Shelton
• Angela Jane Shelton, PHD
• Bettina N Shelton, FNP-BC

• Family Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.