Active NPI
Amy Shackelford
- Health Educator
- Kenosha, WI
National Provider Identifier
1649609165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- 1570-19
- Practice address
- 1703 60TH St
Kenosha, WI 53140-3986 - Phone
- (262) 658-4125
- NPI assigned
- Nov 5, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Health Educator | 174H00000X | 1570-19 | WI | Primary |
Addresses
Primary practice location
1703 60TH St
Kenosha, WI 53140-3986
Mailing address
1703 60TH St
Kenosha, WI 53140-3986
Phone (262) 658-4125
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 |
|---|---|---|---|
| 1570-19 | WI | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383609600000",
"number": "1649609165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1703 60TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531403986",
"telephone_number": "262-658-4125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1703 60TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531403986",
"telephone_number": "262-658-4125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "AMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-05",
"last_updated": "2013-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "WI",
"license": "1570-19",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.