Thomas Shane McMullen, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D-2456 Issued in MS

Practice address

353 Highway 15 N
Pontotoc, MS 38863-1103

Phone

(662) 490-1985

Fax

(662) 490-1989

NPI assigned

Oct 16, 2023

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Arcare

  • Federally Qualified Health Center (FQHC)
  • West Memphis, AR
  • NPI 1215523931
  NPD
• Arcare

  • Federally Qualified Health Center (FQHC)
  • Augusta, AR
  • NPI 1275635542
  NPD
• Arcare

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, AR
  • NPI 1821802729
  NPD

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

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1104608058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 497",
            "city": "AUGUSTA",
            "state": "AR",
            "postal_code": "720060497",
            "telephone_number": "870-347-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 HIGHWAY 15 N",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388631103",
            "telephone_number": "662-490-1985",
            "fax_number": "662-490-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMULLEN",
        "first_name": "THOMAS",
        "middle_name": "SHANE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-16",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MS",
            "license": "D-2456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Wood Maynard, O.D
• Tyler Mickey McCay, PHARMD
• Emily L McCormac
• Elizabeth Love McGillivray, LCSW
• Tara McMillen, PHARMD
• Krista McNutt, FNP-C
• Med-Mart Home Care Inc
• Christopher Michael
• Millcreek Schools, LLC
• Mississippi CVS Pharmacy, L.L.C.

• All providers in Pontotoc, MS
• Registered Dietitian in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.