Shelley J Park, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

14554 Issued in CA

Practice address

2 W Fern Ave
Redlands, CA 92373-5916

Phone

(909) 793-3311

Fax

(909) 796-4158

NPI assigned

Jun 5, 2006

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

Other identifiers 1

Other names 1

• Shelley J Anderson Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beaver Medical Group P CGroup PAC ID 0547164295, 251 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Redlands Community Hospital Hospital, Redlands, CA, CCN 050272

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: spark11163@epiclp.direct-ci.com

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.

• Beaver Medical Group P C

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319
  Medicare reassignment Care Compare group NPD
• Healthcare Partners Affiliates Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  Medicare reassignment NPD
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281
  NPD
• Healthcare Partners Affiliates Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Murrieta, CA
  • NPI 1760057269
  NPD
• Beaver Medical Group P C

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1275570830
  NPD (past)
• Redlands Community Hospital

  • General Acute Care Hospital
  • Redlands, CA
  • NPI 1043354111
  NPD (past)

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

• Redlands Community Hospital

  • General Acute Care Hospital
  • Redlands, CA
  • NPI 1043354111
  Care Compare affiliation

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767571200000",
    "number": "1386683480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 W FERN AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735916",
            "telephone_number": "909-793-3311",
            "fax_number": "909-796-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SHELLEY",
        "middle_name": "J",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "14554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ08162Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLEY",
            "last_name": "ANDERSON",
            "middle_name": "J",
            "credential": "N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chloe Mihyeonhan Park, DDS
• Ellen Park, DDS
• Jonathan Park
• Kenneth J Park, DO
• Moses I Park, M.D.
• Soon Jun Park, DDS
• Darby Alice Parker, OTRL, CHT
• Telisa Sharesse Parker
• Heather Kathleen Parlett, PA-C
• Laura Stella Parra Puerto, LMFT

• Nurse Practitioner in Redlands, CA
• Providers in Redlands, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2026; 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.

Verify at the official NPI Registry.