Active NPI
Shelly Dawn Anderson, DNP APRN, CNP
- Family Nurse Practitioner
- Poteau, OK
National Provider Identifier
1346639283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 88955
- Practice address
- 2104 N Broadway St
Unit a
Poteau, OK 74953-2538 - Phone
- (918) 564-2726
- Fax
- (918) 564-2732
- NPI assigned
- Jan 15, 2015
- Last updated
- Aug 19, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 88955 | OK | Primary |
Addresses
Primary practice location
2104 N Broadway St
Unit a
Poteau, OK 74953-2538
Mailing address
2104 N Broadway St Unit a
Poteau, OK 74953-2538
Phone (918) 385-1544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200571200 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2505 N Broadway St
Poteau, OK 74953-2050
Phone (918) 564-2726
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 88955 | OK | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anderson Family Medical Clinic, LLC | Current | Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients | |
| Leflore County Hospital Authority | Past | Accepting new patients |
Locations
2104 N Broadway St
Unit A
Poteau, OK 74953
Phone (918) 564-2726
2505 N Broadway St
Poteau, OK 74953
Phone (918) 564-2726
Organizations & group practices 3
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.
-
- Health Service Clinic/Center
- Poteau, OK
- NPI 1790398360
-
dba Eastern Oklahoma Medical Center
- Critical Access Hospital
- Poteau, OK
- NPI 1396767158
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Stigler, OK
- NPI 1891920211
-
- Home Health Agency
- McAlester, OK
- NPI 1053423681
-
dba Mountain Gateway Senior Health
- Psychiatric Hospital Unit
- Poteau, OK
- NPI 1184997447
-
dba Eastern Oklahoma Medical Center
- Critical Access Hospital
- Poteau, OK
- NPI 1396767158
-
- Home Health Agency
- Tulsa, OK
- NPI 1063837706
-
dba Traditions Health of Idabel
- Home Health Agency
- Idabel, OK
- NPI 1003552894
-
dba Baptist Health - Fort Smith
- General Acute Care Hospital
- Fort Smith, AR
- NPI 1710463146
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597795200000",
"number": "1346639283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2104 N BROADWAY ST UNIT A",
"city": "POTEAU",
"state": "OK",
"postal_code": "749532538",
"telephone_number": "918-385-1544",
"fax_number": "918-635-3308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2104 N BROADWAY ST",
"address_2": "UNIT A",
"city": "POTEAU",
"state": "OK",
"postal_code": "749532538",
"telephone_number": "918-564-2726",
"fax_number": "918-564-2732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "SHELLY",
"middle_name": "DAWN",
"name_prefix": "Mrs.",
"credential": "DNP APRN, CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-15",
"last_updated": "2020-08-19",
"certification_date": "2020-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OK",
"license": "88955",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200571200",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poteau, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.