Shanna Shackelford, DNP-APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26359 Issued in TN

Practice address

11100 Old Hwy 64 W
Bolivar, TN 38008

Phone

(901) 300-6808

NPI assigned

Sep 26, 2019

Last updated

Oct 22, 2024By 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

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

27.32 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

91.06

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Beautiful Minds Mental Health Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Bolivar, TN
  • NPI 1770213928
  Medicare reassignment NPD Authorized official
• State of Tennessee-Western Mental Health Institute

  • Psychiatric Hospital
  • Bolivar, TN
  • NPI 1538114020
  Medicare reassignment NPD
• Memphis Psychiatric and Addiction Clinic, PC

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Memphis, TN
  • NPI 1235187949
  NPD

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

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1720639172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9245 POPLAR AVE STE 368",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381387931",
            "telephone_number": "901-300-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 OLD HWY 64 W",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "38008",
            "telephone_number": "901-300-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "SHANNA",
        "name_prefix": "Dr.",
        "credential": "DNP-APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-26",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "26359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Todd E Rutland, M.D.
• Karen Salvaggio, NP
• Debra Dianne Savage, RN
• Shirleys LLC
• Smiles R US Dental Care
• April Smtih
• Merry Anna Snider, DNP
• Southern Express Pharmacy

• Psychiatric/Mental Health Nurse Practitioner in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.