Jennifer Marie Shackelford, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

601 S College Rd
Wilmington, NC 28403-3201

Phone

(910) 962-3280

Fax

(910) 962-4130

NPI assigned

Apr 3, 2019

Last updated

Jul 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Marie Guerra Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jennifer.shackelford.1@25899.direct.athenahealth.com

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.

• Geode Health of North Carolina, PLLC

  • Psychiatry Physician
  • Durham, NC
  • NPI 1588433502
  Medicare reassignment NPD
• Carter Clinic PA

  • Psychiatry Physician
  • Wilmington, NC
  • NPI 1972990877
  NPD (past)

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1255893806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4621 RUNAWAY BAY LN",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284055700",
            "telephone_number": "772-807-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S COLLEGE RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284033201",
            "telephone_number": "910-962-3280",
            "fax_number": "910-962-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-03",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GUERRA",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donna R. Session, M.D.
• Shannon Cook Seufert, PHARM.D.
• Shaun G Seufert, PHARM D
• Emily Severt
• Anna Sevic
• Jarrel Lynne Shackleford, PA-C
• Holly Shadoin, OTR/L
• Susan Passafiume Shafer, LCMHC, LCAS
• Brianna Shaffer
• Holly Candice Shaffer

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.