Shantelise Monique Dickey, DNP, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN199300 Issued in GA

Practice address

300 Howell St
Thomaston, GA 30286-5402

Phone

(706) 975-8662

NPI assigned

May 6, 2019

Last updated

May 6, 2019By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1679138655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HOWELL ST",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302865402",
            "telephone_number": "706-975-8662",
            "fax_number": "706-646-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HOWELL ST",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302865402",
            "telephone_number": "706-975-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKEY",
        "first_name": "SHANTELISE",
        "middle_name": "MONIQUE",
        "name_prefix": "Dr.",
        "credential": "DNP, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-06",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN199300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnny T Deen, MD
• Kenneth Murray Deen, MD
• Kevin Lee Delli-Gatti, MD FAAP
• Matthew Delli-Gatti
• Dental Professionals of Georgia, P.C. (Thomaston Dental)
• DK on the Go Enterprise LLC
• Marion Drennan Dobbs Jr., DDS
• Charles Wayne Dodgen, M.D.
• Jody Lynn Dolan, APRN, PNP-PC
• Edgar Joseph Dollar II, D.O.

• Pediatric Nurse Practitioner in Thomaston, GA
• Providers in Thomaston, GA by specialty
• Pediatric Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; 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.