Kassie Crews Shoup

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN11001429 Issued in FL

Practice address

725 S 6TH St
Macclenny, FL 32063-9653

Phone

(904) 259-3150

NPI assigned

Feb 5, 2019

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Florida Department of Children and Families

  • General Acute Care Hospital
  • Chattahoochee, FL
  • NPI 1710945118
  Medicare reassignment NPD
• Tailored Healthcare Inc

  • Multi-Specialty Clinic/Center
  • Macclenny, FL
  • NPI 1558086033
  Medicare reassignment NPD
• Florida Department of Children and Families

  • Psychiatric Hospital
  • Macclenny, FL
  • NPI 1013931765
  NPD

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1578028478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11805 HUCKLEBERRY TRL E",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320631802",
            "telephone_number": "904-316-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S 6TH ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320639653",
            "telephone_number": "904-259-3150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOUP",
        "first_name": "KASSIE",
        "middle_name": "CREWS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11001429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Dunn Scarborough, MD
• Serenity at Twin Lakes Inc
• April Lynn Setzer
• Muhammad Asghar Ali Shah, M.D.
• Robert D Sharpe
• Tracie Elaine Sides, LMHC
• Amanda Nicole Simmons
• Rachel Sirois, APRN
• Deborah Lee Slocum, MAG, RD, LD/N, CDE
• Camden Jakob Smith, D.D.S

• Family Nurse Practitioner in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.