Active NPI
Shevonne Lanette Ellison, NP-C
- Family Nurse Practitioner
- Dallas, TX
National Provider Identifier
1235623588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 1-124645
- Practice address
- 4055 Valley View LN
Dallas, TX 75244-5074 - Phone
- (469) 466-7174
- NPI assigned
- Jun 20, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1-124645 | AL | Primary |
Addresses
Primary practice location
4055 Valley View LN
Dallas, TX 75244-5074
Mailing address
6000 Taramore LN
Huntsville, AL 35806-4734
Phone (256) 527-0790
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-124645 | AL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529452800000",
"number": "1235623588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6000 TARAMORE LN",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358064734",
"telephone_number": "256-527-0790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4055 VALLEY VIEW LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752445074",
"telephone_number": "469-466-7174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "SHEVONNE",
"middle_name": "LANETTE",
"name_prefix": "Miss",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-20",
"last_updated": "2018-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AL",
"license": "1-124645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.