Shelby Jackson, FNP-BC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2015011981 Issued in MO

Practice address

17065 US 71
Belton, MO 64012

Phone

(816) 348-1250

NPI assigned

Feb 1, 2022

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

Medicare fee-for-service enrollment

Enrolled in MO

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Medicine Services of Mo LLCGroup PAC ID 1951766559, 85 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Emergency Medicine Services of Mo, LLC

  • Emergency Medicine Physician
  • Independence, MO
  • NPI 1023715182
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1124771993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 CAMELOT DR",
            "city": "RAYMORE",
            "state": "MO",
            "postal_code": "640838313",
            "telephone_number": "816-559-1658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17065 US 71",
            "city": "BELTON",
            "state": "MO",
            "postal_code": "64012",
            "telephone_number": "816-348-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHELBY",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2015011981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ian R Kuklenski DDS PC
• Innovative Vision Care, LLC
• Innovative Vision Home Care LLC
• Inspired Growth Counseling, LLC
• J Monroe & Company LLC
• Brian H Jenkins, DDS
• Laura Jennings, R.N.
• John Holmes, D.D.S., Belton Modern Dentistry, P.C.
• Danny Wayne Johnson, LPC
• Michelle Lynn Jones

• Registered Nurse in Belton, MO
• Providers in Belton, MO by specialty
• Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.