Shelly R Davis, MN BSN-RN PHN CCHP

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

546189 Issued in CA

Practice address

810 S Main Street
Yreka, CA 96097

Phone

(530) 841-2140

NPI assigned

Nov 7, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Shelly R Bartlett, Wyatt, Johnston Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• County of Siskiyou

  • Public Health or Welfare Agency
  • Yreka, CA
  • NPI 1740043231
  NPD Authorized official
• Siskiyou County Public Health Department

  • Public Health or Welfare Agency
  • Yreka, CA
  • NPI 1881782639
  NPD

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

{
    "created_epoch": "1730937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1275356164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 S MAIN STREET",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "96097",
            "telephone_number": "530-841-2140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 S MAIN STREET",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "96097",
            "telephone_number": "530-841-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "SHELLY",
        "middle_name": "R",
        "credential": "MN BSN-RN PHN CCHP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-07",
        "last_updated": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "850299",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CA",
            "license": "546189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "BARTLETT, WYATT, JOHNSTON",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Davis Dental Corporation
• Cheyenne Carmen Rose Davis, B.A.
• Haley Davis
• Linda Sue Davis
• Monte Kirk Davis, BHS II
• Stephen Glen Davis II, PSY.D.
• Sharon Kay Dawson, CRNFA
• Louis Derouchey, MD
• Michel-Ann R Dias, M.D.
• Tracee Diaz

• Community Health Registered Nurse in Yreka, CA
• Providers in Yreka, CA by specialty
• Community Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.