Jacqueline Faith Shroades, CFNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

110249 Issued in WV

Practice address

190 Campus Blvd Ste 400
Winchester, VA 22601-2872

Phone

(540) 667-1727

NPI assigned

Jun 12, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jacqueline Bennett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Winchester Pediatric Clinic PC

  • Pediatrics Physician
  • Winchester, VA
  • NPI 1295846202
  NPD (past)

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1114289535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 CAMPUS BLVD STE 400",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012872",
            "telephone_number": "540-667-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 CAMPUS BLVD STE 400",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012872",
            "telephone_number": "540-667-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHROADES",
        "first_name": "JACQUELINE",
        "middle_name": "FAITH",
        "name_prefix": "Mrs.",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-12",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001196726",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WV",
            "license": "72420",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "110249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "BENNETT",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacqueline A Shoemaker, RN, FNP-BC
• Amanda Caroline Short
• Julia Showers
• Utsav Shrestha
• Edward Leroy Shriver, CRNA
• Shirley Shultz
• Archana K Shyamsunder, M.D.
• Emily Ann Shygelski
• Si-Hyeon Lee, DMD, PC
• Janine Stewart Siebens, LCSW

• Family Nurse Practitioner in Winchester, VA
• Providers in Winchester, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.