Shelley Dawn King

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

4019 Issued in TN

Practice address

250 N Parkway
Suite 4
Jackson, TN 38305-2735

Phone

(731) 668-1372

Fax

(731) 664-9919

NPI assigned

Jul 11, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Shelley Dawn Moncier Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Extendicare of West TN

  • Home Health Agency
  • Jackson, TN
  • NPI 1356606735
  NPD (past) Authorized official

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341964800000",
    "number": "1760747166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 THORNFIELD DR",
            "city": "BELLS",
            "state": "TN",
            "postal_code": "380065128",
            "telephone_number": "731-660-2171",
            "fax_number": "731-660-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N PARKWAY",
            "address_2": "SUITE 4",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052735",
            "telephone_number": "731-668-1372",
            "fax_number": "731-664-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "SHELLEY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2012-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "4019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLEY",
            "last_name": "MONCIER",
            "middle_name": "DAWN",
            "prefix": "MRS.",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ericka King
• Kristin King, OD
• Lisa Dunivan King, NP
• Lisa Michelle King, PHARMD
• Michael Wayne King, D.D.S.
• Sonya Renai King, RN
• Kings & Queens LLC
• Jennifer F. Kinman, PHARM.D.
• Keiera Shanay Kirby
• Kierstie Dawn Kirby

• All providers in Jackson, TN
• Physical Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; 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.