Shelby Watkins, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1120 Perimeter Park Dr
Cookeville, TN 38501-0922

Phone

(931) 322-5157

NPI assigned

Mar 22, 2024

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

Enrolled in TN

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

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innova Dermatology PCGroup PAC ID 7416298104, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swatkins@cookevilledermatology.emadirect.md

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.

• Innova Dermatology PC

  • MOHS-Micrographic Surgery Physician
  • Hendersonville, TN
  • NPI 1801362231
  Medicare reassignment Care Compare group NPD
• Lisa M Whiteaker, MD

  • Dermatology Physician
  • Cookeville, TN
  • NPI 1306811427
  Medicare reassignment
• Lisa Whiteaker MD

  • Medical Specialty Clinic/Center
  • Cookeville, TN
  • NPI 1043895659
  NPD

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1396595419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 GRANVILLE RD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370642068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 PERIMETER PARK DR",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385010922",
            "telephone_number": "931-322-5157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATKINS",
        "first_name": "SHELBY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Washington Ave Family Practice
• William Walter Wassynger, M.D.
• Mark Wathen, MD
• Jimmie Gregory Watkins, DPM
• Sharonda Watkins
• Tammy Watkins
• Sunday Watson
• Mary Erika Watts, PHARMD.
• Summer R Weary, D.P.M.
• Thomas Weaver

• Physician Assistant in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.