Individual provider Active NPI

Shentreda Person, LPN

  • Licensed Practical Nurse
  • Crestview, FL
National Provider Identifier
1639084072
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
PN5253106 Issued in FL
Practice address
226 Secretariat Dr
Crestview, FL 32539-6093
Phone
(448) 249-5946
NPI assigned
Aug 18, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X PN5253106 FL Primary

Addresses

Primary practice location

226 Secretariat Dr
Crestview, FL 32539-6093

Mailing address

226 Secretariat Dr
Crestview, FL 32539-6093
Phone (448) 249-5946

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

NPI Registry JSON

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

{
    "created_epoch": "1787011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1639084072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 SECRETARIAT DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325396093",
            "telephone_number": "448-249-5946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 SECRETARIAT DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325396093",
            "telephone_number": "448-249-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSON",
        "first_name": "SHENTREDA",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-08-18",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5253106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; 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.