Individual provider Active NPI

Shirree Shinellec Holliday, C.N.A

  • Nurse's Aide
  • Jackson, TN
National Provider Identifier
1518391085
Registry record updated Sep 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse's AideTaxonomy code 376K00000X
License
115963 Issued in TN
Practice address
248 N Fairgrounds St
Jackson, TN 38301-5130
Phone
(731) 225-4412
NPI assigned
Sep 3, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse's Aide 376K00000X 115963 TN Primary
Nurse's Aide 376K00000X A070530 MS

Addresses

Primary practice location

248 N Fairgrounds St
Jackson, TN 38301-5130

Mailing address

248 N Fairgrounds St
Jackson, TN 38301-5130
Phone (731) 225-4412

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

LicenseStateTypeSpecialty
A070530MSMDNurse's Aide
115963TNMDNurse's Aide

NPI Registry JSON

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378166400000",
    "number": "1518391085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 N FAIRGROUNDS ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383015130",
            "telephone_number": "731-225-4412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 N FAIRGROUNDS ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383015130",
            "telephone_number": "731-225-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIDAY",
        "first_name": "SHIRREE",
        "middle_name": "SHINELLEC",
        "name_prefix": "Mr.",
        "credential": "C.N.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "TN",
            "license": "115963",
            "primary": true
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "MS",
            "license": "A070530",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; 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.