Active NPI
Roderick Darnell Shine, CRNP
- Critical Care Neonatal Nurse Practitioner
- Montgomery, AL
National Provider Identifier
1215459854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Neonatal Nurse Practitioner
- License
- 1-120663
- Practice address
- 2105 E South Blvd
Montgomery, AL 36116-2409 - Phone
- (334) 288-2100
- NPI assigned
- Jul 15, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Neonatal Nurse Practitioner | 363LN0005X | 1-120663 | AL | Primary |
Addresses
Primary practice location
2105 E South Blvd
Montgomery, AL 36116-2409
Mailing address
90 Emerald Dr
Pike Road, AL 36064-2932
Phone (334) 294-8029
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-120663 | AL | MD | Critical Care Neonatal Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500076800000",
"number": "1215459854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 EMERALD DR",
"city": "PIKE ROAD",
"state": "AL",
"postal_code": "360642932",
"telephone_number": "334-294-8029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 E SOUTH BLVD",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361162409",
"telephone_number": "334-288-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHINE",
"first_name": "RODERICK",
"middle_name": "DARNELL",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-15",
"last_updated": "2017-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LN0005X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Neonatal, Critical Care",
"state": "AL",
"license": "1-120663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.