Shelby Faltynski, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71005391A Issued in IN

Practice address

1111 Lighthouse LN
Goshen, IN 46526-3824

Phone

(574) 533-8925

Fax

(574) 533-0277

NPI assigned

Mar 5, 2015

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1425513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1205229952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 LIGHTHOUSE LANE",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465263824",
            "telephone_number": "574-533-0348",
            "fax_number": "574-533-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 LIGHTHOUSE LN",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465263824",
            "telephone_number": "574-533-8925",
            "fax_number": "574-533-0277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "244 S Olive St",
            "address_2": "Suite E",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466192100",
            "country_code": "US",
            "telephone_number": "574-282-3230",
            "fax_number": "574-282-3240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FALTYNSKI",
        "first_name": "SHELBY",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-05",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71005391A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "28190483A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200817480",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Goshen, IN
• Providers in Goshen, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.