Jennifer Shattuck, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

153737 Issued in NC

Practice address

1638 Owen Dr
Fayetteville, NC 28304-3424

Phone

(910) 609-6440

Fax

(910) 609-5365

NPI assigned

Nov 9, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202947200000",
    "number": "1104807957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-609-6448",
            "fax_number": "910-609-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043424",
            "telephone_number": "910-609-6440",
            "fax_number": "910-609-5365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "JENNIFER",
        "name_prefix": "Miss",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2008-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "153737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "185460",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8052350",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Kendall Sharp, FNP
• Marlo Rebecca Sharp, CNM
• Shawnesty Dawn Sharpe
• Sharper Images of Fayetteville, Inc
• Jeffrey Dale Shatterly, RPH
• Tanveer Shaukat, MD
• Chavonne Nakia Shaw
• Dayco Lashell Shaw
• Shenethia Fenner Shaw, LCMHCS, NCC
• Tomeka Davis Shaw, LPC, NCC

• Certified Registered Nurse Anesthetist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Certified Registered Nurse Anesthetist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; 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.