Shelly J Carnevale, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704230671 Issued in MI

Practice address

710 Kenmoor Ave SE Ste 200
Grand Rapids, MI 49546-2379

Phone

(616) 588-7246

NPI assigned

Sep 11, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Credentials

Nurse Practitioner, Registered Nurse

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.

• West Michigan Pain Center PC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Grand Rapids, MI
  • NPI 1447973060
  Medicare reassignment NPD
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1326567413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 KENMOOR AVE SE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462379",
            "telephone_number": "616-588-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 KENMOOR AVE SE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462379",
            "telephone_number": "616-588-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARNEVALE",
        "first_name": "SHELLY",
        "middle_name": "J",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704230671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Carmichael, MA
• Haven Chiffonne Carmichael, BSW
• Kaleb Carmichael
• Ryan James Carmody, PA
• Patrick R Carnes, CAA
• Carole Walters Counseling
• Caroline Lowry Hall
• Carolyn L Madry Counseling LLC
• Ashley Caron, PHARM D
• Abigail G Carpenter

• Family Nurse Practitioner in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.