Jeffrey Thomas Shadrach, AGNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2021044288 Issued in MO

Practice address

13655 Riverport Dr
Maryland Heights, MO 63043-4812

Phone

(314) 592-7000

NPI assigned

Jun 24, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1235861766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4918 SILO HILLS DR",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658027121",
            "telephone_number": "417-844-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13655 RIVERPORT DR",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630434812",
            "telephone_number": "314-592-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADRACH",
        "first_name": "JEFFREY",
        "middle_name": "THOMAS",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-24",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2021044288",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2021044288",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Maryland Heights, MO
• Providers in Maryland Heights, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; 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.