Judith D Shackelford, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

18137 Issued in WV

Practice address

Fairmont General Hospital
1325 Locust Avenue
Fairmont, WV 26554

Phone

(304) 367-7267

Fax

(304) 367-7503

NPI assigned

Oct 6, 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 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Association of Anesthesia Providers, LLC

  • Anesthesiology Physician
  • Fairmont, WV
  • NPI 1235235961
  NPD (past)
• Center for Pain Relief, Inc.

  • Interventional Pain Medicine Physician
  • Charleston, WV
  • NPI 1831116375
  NPD (past)
• Marion Anesthesia Associates Inc

  • Anesthesiology Physician
  • Fairmont, WV
  • NPI 1336198860
  NPD (past)
• Premier Anesthesia of Fairmont, WV, a Division of Premier Anesthesia

  • Anesthesiology Physician
  • Fairmont, WV
  • NPI 1154595031

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1447347117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11302",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253391302",
            "telephone_number": "304-346-9400",
            "fax_number": "304-720-8461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FAIRMONT GENERAL HOSPITAL",
            "address_2": "1325 LOCUST AVENUE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "26554",
            "telephone_number": "304-367-7267",
            "fax_number": "304-367-7503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "JUDITH",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "18137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MSBCBS",
            "identifier": "001907661",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MTN. STATE BLUE CROSS",
            "identifier": "001721190",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0066583000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006746",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DF0767",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AAP TRI CARE",
            "identifier": "205542387",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00377021",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0166583000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "20554238700",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Seese
• Sharon Ann Senft, CFNP
• Meagan Ann Seremetis, OTR/L
• Cassandra Sevier
• Johnna Sevilla
• Amanda Cheyenne Shaffer
• Brittany Shaffer, MSW, LGSW
• Cheyenne Lane Shaffer
• Elizabeth Shamblen
• Amy Jo Shannon, SLP

• Certified Registered Nurse Anesthetist in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Certified Registered Nurse Anesthetist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.