Shanti Elizabeth Herzog, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP60791095 Issued in WA

Practice address

6334 Littlerock Rd SW
Tumwater, WA 98512-7332

Phone

(360) 704-7590

Fax

(360) 704-7591

NPI assigned

Aug 20, 2015

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2025 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sherzog108928@direct.multicare.org

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.

• Olympia Mental Health and Psychiatry PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lacey, WA
  • NPI 1164198628
  NPD Authorized official
• Pride & Joy Gender Affirming Care Clinic PLLC

  • Health Service Clinic/Center
  • Olympia, WA
  • NPI 1134098627
  NPD Authorized official
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Tumwater, WA
  • NPI 1679766620
  NPD
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Tumwater, WA
  • NPI 1841486339
  NPD (past)

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1770959025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E YESLER WAY",
            "address_2": "STE 210",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225959",
            "telephone_number": "503-988-7468",
            "fax_number": "503-988-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6334 LITTLEROCK RD SW",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985127332",
            "telephone_number": "360-704-7590",
            "fax_number": "360-704-7591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "SHANTI",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-20",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60791095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22959",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096511",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Jo Hergert, LCSW, LICSW
• William Herland
• Pastora Hernandez Barbee, ED.D, LMHC
• Laura Kathryn Herrick, LMT
• Michelle Lynn Herron, LMP
• Terrence Eugene Hess, D.P.M.
• Kleandria Hester, LMHCA
• Laurie Heuermann, MD
• Meleah Hickman
• Erika Hicks-Prince, CAAR,CDPT

• Family Nurse Practitioner in Tumwater, WA
• Providers in Tumwater, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.