Stephen Chase Shacklett, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

25946 Issued in SC

Practice address

404 S Sutherland Ave
Monroe, NC 28112-5060

Phone

(704) 291-9267

NPI assigned

Feb 21, 2022

Last updated

Apr 1, 2022By the provider in NPPES

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

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: ms_sshackle@landmarkhealth-direct.org

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1265187082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 E BLAND ST UNIT 272",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282036149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 S SUTHERLAND AVE",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281125060",
            "telephone_number": "704-291-9267"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 Main St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292013266",
            "country_code": "US",
            "telephone_number": "866-949-0108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACKLETT",
        "first_name": "STEPHEN",
        "middle_name": "CHASE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "F01220897",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "25946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Home Care Services Inc
• Serenity House
• Raquel Serrano, PA
• Olivia Sessions, MA, LPCA
• Anjali Seth, D.D.S.
• Pat Geary Shafer, CRNA
• Deval Bhadrashil Shah, NP
• Devendra C. Shah, M.D.
• Jay N. Shah, MD
• Priyank Pankajkumar Shah, M.D.

• Family Nurse Practitioner in Monroe, NC
• Providers in Monroe, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; 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.