Shelly Marie Whitehead, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

311522 Issued in TX

Practice address

3015 Herring Ave
Waco, TX 76708-3238

Phone

(888) 236-4567

NPI assigned

Oct 28, 2022

Last updated

Oct 28, 2022By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1538876602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 STRATFORD DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767105621",
            "telephone_number": "254-265-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 HERRING AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083238",
            "telephone_number": "888-236-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHEAD",
        "first_name": "SHELLY",
        "middle_name": "MARIE",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-28",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "TX",
            "license": "311522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD OF NURSING",
            "identifier": "311522",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffery Randall White, M.D.
• Jessica White, OTR
• Kirstin White, BA
• Sarah O White
• Thomas Brian White, MD
• Severine M Whittier, CRNA
• Matthew S Wiberg
• Wic, LTD. (Waco Open MRI)
• Kimberly Wical
• Clarence Louis Widmann, O.D.

• Licensed Vocational Nurse in Waco, TX
• Providers in Waco, TX by specialty
• Licensed Vocational Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.

Verify at the official NPI Registry.