Tanna Shockley, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A005012 Issued in AR

Practice address

1652 State Highway 22 W
Dardanelle, AR 72834-2909

Phone

(479) 229-8000

Fax

(833) 637-1613

NPI assigned

Jan 23, 2017

Last updated

Feb 13, 2024By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Kirkland Family Medical Center PAGroup PAC ID 7214063031, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Russellville, AR, CCN 047850
• St Marys Regional Medical Center Hospital, Russellville, AR, CCN 040041

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tanna.shockley.1@2110.direct.athenahealth.com

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.

• The Kirkland Family Medical Center, PA

  • Preferred Provider Organization
  • Dardanelle, AR
  • NPI 1316145022
  Medicare reassignment Care Compare group NPD
• Ozark Health, Inc

  dba Ozark Medical Clinic

  • Rural Health Clinic/Center
  • Clinton, AR
  • NPI 1366614935
  Medicare reassignment NPD
• Ozark Health, Inc

  dba Ozark Medical Clinic - Fairfield Bay

  • Rural Health Clinic/Center
  • Fairfield Bay, AR
  • NPI 1477960581
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kah Development 4, LLC

  dba CenterWell Home Health

  • Home Health Agency
  • Russellville, AR
  • NPI 1912357948
  Care Compare affiliation
• Russellville Holdings LLC

  dba St . Mary's Regional Medical Center

  • General Acute Care Hospital
  • Russellville, AR
  • NPI 1033160049
  Care Compare affiliation

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

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1487191987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1652 STATE HIGHWAY 22 W",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "728342909",
            "telephone_number": "479-229-8000",
            "fax_number": "833-637-1613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1652 STATE HIGHWAY 22 W",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "728342909",
            "telephone_number": "479-229-8000",
            "fax_number": "833-637-1613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2526 Highway 65 S",
            "address_2": "Ste 201",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "AR",
            "postal_code": "720316657",
            "country_code": "US",
            "telephone_number": "501-745-3388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "TANNA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-23",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A005012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A005012",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rose Drug of Dover, Inc (Berry Drug of Dardanelle)
• William Patrick Scott, MD
• SDS Emergency Staffing LLC
• Matthew Self, MD
• Jill M Sheets, P.D.
• Charles Burrell Smith Jr., D.C.
• Annette Kay Snider, LCSW
• State of Arkansas (Yell County Health Unit Dardanelle)
• Kristy Leigh Stokes, L.P.C.
• Susan Rebekah Stuck

• Family Nurse Practitioner in Dardanelle, AR
• Providers in Dardanelle, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.