NPIMap

Individual provider Active NPI

Shelli R Crockett, NP

  • Family Nurse Practitioner
  • Winchester, VA
National Provider Identifier
1366548430
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024164715 Issued in VA
Practice address
172 Linden Dr Ste 100
Winchester, VA 22601-2892
Phone
(540) 722-8172
NPI assigned
Sep 16, 2006
Last updated
Dec 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024164715 VA Primary

Addresses

Primary practice location

172 Linden Dr Ste 100
Winchester, VA 22601-2892

Mailing address

172 Linden Dr
Ste 100
Winchester, VA 22601-2892
Phone (276) 679-8890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040722001017 VA Practitioner - Nurse Practitioner 2769462415 Reassigns benefits to 1 organization
I20240430001396 FL Practitioner - Nurse Practitioner 2769462415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

172 Linden Dr
Winchester, VA 22601-2892

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024164715VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince May 13, 2016 Accepting new patients
Privia Medical Group Florida, LLC CurrentSince Jan 1, 2025 Accepting new patients
Privia Medical Group, LLC CurrentSince May 13, 2016 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Norton Community Physician Services LLC Past Accepting new patients
Norton Community Physician Services LLC Past Accepting new patients

Locations

140 6th Ave
Indialantic, FL 32903
Phone (321) 312-3501

870 W Hickpochee Ave
Ste 100
Labelle, FL 33935
Phone (239) 303-1501

989 Sebastian Blvd
Unit 3
Sebastian, FL 32958
Phone (727) 617-1777

950 N Glebe Rd
Ste 4000
Arlington, VA 22203
Phone (301) 593-9011

8644 Sudley Rd
#220
Manassas, VA 20110

148 Linden Dr
Ste 103
Winchester, VA 22601
Phone (540) 722-0627

172 Linden Dr
Ste 100
Winchester, VA 22601
Phone (540) 722-8172

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: shelli.crockett.1@8042.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1366548430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 LINDEN DR",
            "address_2": "STE 100",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012892",
            "telephone_number": "276-679-8890",
            "fax_number": "276-679-9740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 LINDEN DR STE 100",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012892",
            "telephone_number": "540-722-8172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "SHELLI",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024164715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, VA

Sources for this page

Verify at the official NPI Registry.