Shelley Ann Smith, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5008216 Issued in NC

Practice address

501 Main St
Gatesville, NC 27938-9424

Phone

(252) 357-1226

Fax

(252) 357-1236

NPI assigned

Dec 9, 2015

Last updated

Aug 19, 2020By 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 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Duke University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gateway Community Health Centers, Inc.Group PAC ID 9234356015, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sentara Albemarle Medical Center Hospital, Elizabeth City, NC, CCN 340109

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gateway Community Health Centers, Inc.

  dba Gateway Community Health

  • Federally Qualified Health Center (FQHC)
  • Elizabeth City, NC
  • NPI 1487936514

  Family

  Medicare reassignment Care Compare group NPD
• Gates County Medical Center LLC

  • Primary Care Clinic/Center
  • Gatesville, NC
  • NPI 1639217631
  NPD
• Gateway Community Health Centers, Inc

  dba Gateway Community Health Centers Pharmacy Gatesville

  • Clinic Pharmacy
  • Gatesville, NC
  • NPI 1447843370
  NPD

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

• Sentara Albemarle Regional Medical Center

  dba Sentara Albemarle Medical Center

  • General Acute Care Hospital
  • Elizabeth City, NC
  • NPI 1245211168
  Care Compare affiliation

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1588039036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 297",
            "city": "GATESVILLE",
            "state": "NC",
            "postal_code": "279380297",
            "telephone_number": "252-357-1226",
            "fax_number": "252-357-1236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MAIN ST",
            "city": "GATESVILLE",
            "state": "NC",
            "postal_code": "279389424",
            "telephone_number": "252-357-1226",
            "fax_number": "252-357-1236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Sunnybrook Rd",
            "address_2": "Clinic B",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276101808",
            "country_code": "US",
            "telephone_number": "919-250-3078",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 E Ehringhaus St",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279094941",
            "country_code": "US",
            "telephone_number": "252-333-1047",
            "fax_number": "252-384-2652",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2060 Detwiler Rd",
            "address_purpose": "LOCATION",
            "city": "Harleysville",
            "state": "PA",
            "postal_code": "194382934",
            "country_code": "US",
            "telephone_number": "800-557-8272 x558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHELLEY",
        "middle_name": "ANN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-09",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP140666",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "MS5229895",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CPN191034",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "C-APN.0001453-C-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5008216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Gardiner Mahar, PA-C
• Candice S Mathis, PHARM D
• McDowells Pharmacy of Gates County, LLC (McDowell's Pharmacy of Gates County)
• Sherri Minton
• Laura Monroe
• The Davis Housing Group
• Todds Pharmacy of Gates Co Inc
• Todds Pharmacy of Gates Co Inc
• Todds Pharmacy of Gates County
• Lakedra Camilla White

• Family Nurse Practitioner in Gatesville, NC
• Providers in Gatesville, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.