Active NPI
Shane Bratcher
- Speech-Language Pathologist
- Farmington, NM
National Provider Identifier
1578045506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- CF6493
- Practice address
- 5840 Fortuna Dr
Farmington, NM 87402-8210 - Phone
- (505) 599-8625
- NPI assigned
- Sep 6, 2018
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | CF6493 | NM | Primary |
Addresses
Primary practice location
5840 Fortuna Dr
Farmington, NM 87402-8210
Mailing address
5840 Fortuna Dr
Farmington, NM 87402-8210
Phone (505) 599-8625
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
| License | State | Type | Specialty |
|---|---|---|---|
| CF6493 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536192000000",
"number": "1578045506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5840 FORTUNA DR",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874028210",
"telephone_number": "505-599-8625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5840 FORTUNA DR",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874028210",
"telephone_number": "505-599-8625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRATCHER",
"first_name": "SHANE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-06",
"last_updated": "2018-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "CF6493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.