Candice Nicole Short, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

19004 Issued in TN

Practice address

2151 Century LN
Johnson City, TN 37604-4469

Phone

(423) 439-4515

Fax

(423) 439-5780

NPI assigned

Jul 29, 2014

Last updated

May 3, 2017By the provider in NPPES

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

• Candice Nicole King Former name

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

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brookwell Health LLCGroup PAC ID 4981033032, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Brookwell Health LLC

  dba BrookWell Infusion

  • Nurse Practitioner
  • Morristown, TN
  • NPI 1366072159
  Medicare reassignment Care Compare group NPD
• East Tennessee State University

  dba Mountain City Extended Hours Health Center

  • Rural Health Clinic/Center
  • Mountain City, TN
  • NPI 1295779361
  NPD

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

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493769600000",
    "number": "1407264971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 STOUT DRIVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 CENTURY LN",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044469",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORT",
        "first_name": "CANDICE",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-29",
        "last_updated": "2017-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "19004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q007448",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDICE",
            "last_name": "KING",
            "middle_name": "NICOLE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Shirley, SLP
• Roger Dwayne Shockey Sr., FNP
• Christopher W. Sholes, MD
• Laura Ann Sholes, APN-BC
• Paige Leslie Sholes, PHARMD
• Janie Allene Short, LCSW
• Ryan T Short, FNP
• Wayne Keith Shorter II, MED
• Ashley E Shortridge
• Franchesca Maria Shoun, APN

• Family Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; 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.