Shasta Leann Ebert

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5005908 Issued in NC

Practice address

125 Days Inn Dr
Mooresville, NC 28117-6323

Phone

(704) 660-9111

Fax

(704) 663-4504

NPI assigned

Nov 5, 2012

Reactivated

Feb 23, 2022

Last updated

Jan 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Novant Health Employer Solutions, LLC

  dba NHES Ins Bill

  • Occupational Medicine Physician
  • Charlotte, NC
  • NPI 1407668700
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Northlake Dermatology

  • Dermatopathology Physician
  • Huntersville, NC
  • NPI 1396751640
  NPD (past)

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1093069627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 PECANBLUFF CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282162662",
            "telephone_number": "704-560-9158",
            "fax_number": "336-277-4672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 DAYS INN DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176323",
            "telephone_number": "704-660-9111",
            "fax_number": "704-663-4504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERT",
        "first_name": "SHASTA",
        "middle_name": "LEANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-05",
        "last_updated": "2024-01-03",
        "certification_date": "2022-03-10",
        "deactivation_date": "2022-02-03",
        "reactivation_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5005908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SEBERT191893@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "125 Days Inn Dr",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281176323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melissa Lee Dunlop, P.T.,M.S.P.T.,D.P.T.
• Cathlene Marie Durkos, OTR/L
• Laura Maude Duskin, M.D.
• Shirley J Dzikowski, P.T.
• Patricia Easton
• Eckerd Corporation (Rite Aid Pharmacy 11457)
• Stefani T Eddins
• Edgewater Women's Health Centre
• William John Edmiston Jr., MD
• Haili Edwards

• Family Nurse Practitioner in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; 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.