Cicely Shankle

Primary specialty

NutritionistTaxonomy code 133N00000X

License

146810 Issued in AK

Practice address

600 University Ave Ste 2a
Fairbanks, AK 99709-3651

Phone

(907) 206-3000

Fax

(907) 331-0480

NPI assigned

May 22, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Alaska Urological Institute PC

  • Urology Physician
  • Anchorage, AK
  • NPI 1689716185
  NPD (past)
• White Spruce Medical Inc

  • Naturopath
  • Fairbanks, AK
  • NPI 1215983259
  NPD (past)

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1396302519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 UNIVERSITY AVE STE 2A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093651",
            "telephone_number": "907-206-3000",
            "fax_number": "907-331-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 UNIVERSITY AVE STE 2A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093651",
            "telephone_number": "907-206-3000",
            "fax_number": "907-331-0480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3039 Davis Rd",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997095234",
            "country_code": "US",
            "telephone_number": "907-452-3600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANKLE",
        "first_name": "CICELY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "AK",
            "license": "146810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael F Sexton
• Elise Michelle Shahan, FNP-C
• Kendra Kay Shaner, OTR/L, CHT
• Shangri'la Ranch
• Chance Shank
• Kelly Shanklin
• Theresa Joanne Shanley, M.D.
• Vanessa Shannon
• Nisha Sharma
• Brandie Price Sharp, ACCNS-AG, RNFA

• Nutritionist in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Nutritionist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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.