Kim Shackleford, FNTP

Primary specialty

NutritionistTaxonomy code 133N00000X

Practice address

3830 Casey Leigh LN
Raleigh, NC 27612-4258

Phone

(919) 427-5946

NPI assigned

Jul 29, 2022

Last updated

Jul 29, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kim Shackleford Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1659052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1376279513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 CASEY LEIGH LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124258",
            "telephone_number": "919-427-5946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 CASEY LEIGH LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124258",
            "telephone_number": "919-427-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLEFORD",
        "first_name": "KIM",
        "name_prefix": "Ms.",
        "credential": "FNTP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-29",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Desktop",
            "affiliation": "N",
            "endpointDescription": "I am using this for medical information of  lab work and medical history",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": ".msg",
            "address_1": "3830 Casey Leigh Ln",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276124258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "SHACKLEFORD",
            "credential": "FNTP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Georgia Tina Sgouros, LCSW
• Stephen F Shaban, MD
• Amna Shabbir, M.D.
• Mary C Shackelford, LCSW
• Sarah Shackelford
• Minkha Shadeed
• Brooke Biddle Shaefer, OTR/L
• Megan Walldine Shaeffer, RBT
• Susan Ann Shafer, CRNA
• Lisa Ann Shaffer, LBSW

• Nutritionist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Nutritionist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; 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.