Individual provider Active NPI

Vakeshea Shannon, NP

  • Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1700308806
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
902133 Issued in MS
Practice address
4381 S Eason Blvd Ste 302
Tupelo, MS 38801-6584
Phone
(662) 377-5700
NPI assigned
Jul 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 902133 MS Primary

Addresses

Primary practice location

4381 S Eason Blvd Ste 302
Tupelo, MS 38801-6584

Mailing address

4381 S Eason Blvd Ste 302
Tupelo, MS 38801-6584
Phone (662) 377-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20170830002846 MS Practitioner - Nurse Practitioner 6709159577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4381 S Eason Blvd
Suite 302
Tupelo, MS 38801-6584
Phone (662) 377-5700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medical Center Inc. CurrentSince Jul 13, 2017 Accepting new patients
North Mississippi Medcial Center, Inc. CurrentSince Jul 13, 2017 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients
Amory Surgery Clinic, PLLC Past Accepting new patients

Locations

4381 S Eason Blvd
Ste 302
Tupelo, MS 38801
Phone (662) 377-5700

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Interoperability endpoints

  • Direct secure messaging: vakesheamims@nmhs.medalliesdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1700308806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4381 S EASON BLVD STE 302",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016584",
            "telephone_number": "662-377-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4381 S EASON BLVD STE 302",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016584",
            "telephone_number": "662-377-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "VAKESHEA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-10",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "902133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.