Shelby J'Aun Tatum
Individual provider Active NPI School Registered Nurse · House, NM
NPI 1598435414 · NPPES record last updated Sep 14, 2021
Key facts
- NPI
- 1598435414
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Registered Nurse 163WS0200X
- License
- 77902 (NM)
- Practice address
- 309 Apple Street
House, NM 88121 - Phone
- (575) 279-7353
- NPI assigned
- Sep 14, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77902 | NM | MD | School Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 77902 | NM | Yes |
Addresses
Primary practice location
309 Apple Street
House, NM 88121
Mailing address
PO Box 673
House, NM 88121-0673
Phone (575) 279-7353
Other providers in House, NM
All providers in House, NM · School Registered Nurse in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.