Individual provider Active NPI

Tabatha M Shankle, LCSW

  • Clinical Social Worker
  • Sikeston, MO
National Provider Identifier
1245675396
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2014030736 Issued in MO
Practice address
760 Plantation Blvd
Sikeston, MO 63801-5736
Phone
(573) 471-0800
NPI assigned
May 2, 2013
Last updated
Sep 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2012011602 MO
Clinical Social Worker 1041C0700X 2014030736 MO Primary

Addresses

Primary practice location

760 Plantation Blvd
Sikeston, MO 63801-5736

Mailing address

505 N Main St
Charleston, MO 63834-1030
Phone (573) 683-1211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161222001520 MO Practitioner - Clinical Social Worker 4688982283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Southern Illinois University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bootheel Counseling ServicesGroup PAC ID 5496725145, 21 clinicians

Practice addresses (Care Compare)

760 Plantation Blvd
Sikeston, MO 63801-5736
Phone (573) 471-0800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2012011602MOMDClinical Social Worker
2014030736MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bootheel Counseling Services CurrentSince Aug 26, 2025 Accepting new patients
Bootheel Counseling Services CurrentSince Aug 26, 2025 Accepting new patients
Ferguson Medical Group Rural Health Center Inc. PastSince Oct 1, 2021 Accepting new patients
Bootheel Counseling Services PastSince Dec 3, 2023 Accepting new patients

Locations

760 Plantation Blvd
Sikeston, MO 63801
Phone 5734710880245

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1245675396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N MAIN ST",
            "city": "CHARLESTON",
            "state": "MO",
            "postal_code": "638341030",
            "telephone_number": "573-683-1211",
            "fax_number": "866-312-4304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 PLANTATION BLVD",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015736",
            "telephone_number": "573-471-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANKLE",
        "first_name": "TABATHA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-02",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2012011602",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2014030736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sikeston, MO

Sources for this page

Verify at the official NPI Registry.