Active NPI
Judy Ann Shives, NP-C
- Adult Health Nurse Practitioner
- Winston Salem, NC
National Provider Identifier
1457543365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 122798
- Practice address
- 1100 Reynolds Blvd
Winston Salem, NC 27105-3400 - Phone
- (336) 896-4475
- Fax
- (336) 896-4481
- NPI assigned
- Aug 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 122798 | NC | Primary |
Addresses
Primary practice location
1100 Reynolds Blvd
Winston Salem, NC 27105-3400
Mailing address
1100 Reynolds Blvd
Winston Salem, NC 27105-3400
Phone (336) 896-4475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122798 | NC | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187049600000",
"number": "1457543365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 REYNOLDS BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271053400",
"telephone_number": "336-896-4475",
"fax_number": "336-896-4481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 REYNOLDS BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271053400",
"telephone_number": "336-896-4475",
"fax_number": "336-896-4481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIVES",
"first_name": "JUDY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-14",
"last_updated": "2007-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "NC",
"license": "122798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.