Individual provider Active NPI

Sheimeita Chance, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • Cumming, GA
National Provider Identifier
1144692500
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN207502 Issued in GA
Practice address
1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone
(770) 844-3200
Fax
(404) 851-6325
NPI assigned
Oct 26, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X RN207502 GA Primary

Addresses

Primary practice location

1200 Northside Forsyth Dr
Cumming, GA 30041-7659

Mailing address

1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone (770) 844-3200

Other identifiers 1

IdentifierTypeStateIssuer
003177117AMedicaidGA

Other names 1

  • Sheimeita Ashley Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20160322001125 GA Practitioner - Nurse Practitioner 5092012880 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
KCP Enterprises CurrentSince Aug 15, 2024 Accepting new patients
Beyond Mental Health Wellness LLC Past Accepting new patients

Locations

203 Woodpark Pl
Ste 102
Woodstock, GA 30188
Phone (678) 748-3343

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1144692500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NORTHSIDE FORSYTH DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417659",
            "telephone_number": "770-844-3200",
            "fax_number": "404-851-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NORTHSIDE FORSYTH DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417659",
            "telephone_number": "770-844-3200",
            "fax_number": "404-851-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANCE",
        "first_name": "SHEIMEITA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN207502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003177117A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHEIMEITA",
            "last_name": "ASHLEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.