Active NPI
Shirley Ann Skinner, CRNA
- Certified Registered Nurse Anesthetist
- Dothan, AL
National Provider Identifier
1790740843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 1045691
- Practice address
- 4370 W Main Street
Dothan, AL 36305 - Phone
- (334) 793-5000
- Fax
- (334) 615-8419
- NPI assigned
- Apr 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 1045691 | AL | Primary |
| Certified Registered Nurse Anesthetist | 367500000X | ARNP2697142 | FL |
Addresses
Primary practice location
4370 W Main Street
Dothan, AL 36305
Mailing address
PO Box 6907
Dothan, AL 36302
Phone (334) 793-5000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04689704 | Medicaid | MS | |
| 51515686 | Other | AL | BLUE CROSS BLUE SHIELD |
| 1771414 | Medicaid | LA |
Other names 1
- Shirley Ann Tecca
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1045691 | AL | MD | Certified Registered Nurse Anesthetist |
| ARNP2697142 | FL | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790740843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6907",
"city": "DOTHAN",
"state": "AL",
"postal_code": "36302",
"telephone_number": "334-793-5000",
"fax_number": "334-615-8419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4370 W MAIN STREET",
"city": "DOTHAN",
"state": "AL",
"postal_code": "36305",
"telephone_number": "334-793-5000",
"fax_number": "334-615-8419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKINNER",
"first_name": "SHIRLEY",
"middle_name": "ANN",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "AL",
"license": "1045691",
"primary": true
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "FL",
"license": "ARNP2697142",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04689704",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "51515686",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1771414",
"state": "LA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHIRLEY",
"last_name": "TECCA",
"middle_name": "ANN",
"credential": "CRNA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.