Active NPI
Shane Jaxyn Logen Williams
- Personal Care Attendant
- Moundsville, WV
National Provider Identifier
1467189571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- Practice address
- 206 Ash Ave
Moundsville, WV 26041-1536 - Phone
- (681) 588-7733
- NPI assigned
- Aug 8, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | Primary |
Addresses
Primary practice location
206 Ash Ave
Moundsville, WV 26041-1536
Mailing address
206 Ash Ave
Moundsville, WV 26041-1536
Phone (681) 588-7733
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356607394 | Medicaid | WV | |
| 1821206228 | Medicaid | WV | |
| 125553494 | Medicaid | WV |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659916800000",
"number": "1467189571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 ASH AVE",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "260411536",
"telephone_number": "681-588-7733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 ASH AVE",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "260411536",
"telephone_number": "681-588-7733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "SHANE",
"middle_name": "JAXYN LOGEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-08",
"last_updated": "2022-08-08",
"certification_date": "2022-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1356607394",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1821206228",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "125553494",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moundsville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.