Shawn L Bourke, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

71001672A Issued in IN

Practice address

7120 Clearvista Dr
Suite 4000
Indianapolis, IN 46256-1621

Phone

(317) 577-7444

Fax

(317) 577-7433

NPI assigned

Oct 11, 2006

Last updated

Jul 14, 2015By 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: sbourke11044@ecommunitydirect.com

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436832000000",
    "number": "1801984224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "SUITE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7120 CLEARVISTA DR",
            "address_2": "SUITE 4000",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462561621",
            "telephone_number": "317-577-7444",
            "fax_number": "317-577-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURKE",
        "first_name": "SHAWN",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2015-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IN",
            "license": "71001672A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200956260",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000647937",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Boulos, M.D.
• Michael Boulous, MD
• Jennifer Bouman
• Bounce Back Physical Therapy
• Bourke Homecare LLC
• Matthew Bourne, MS COUNSELING
• Vincent M Bournique, MD
• Kristen Bourque, RD, LD, CLC
• Alexandria Bousamra-Wright, APRN
• John Steven Bousamra

• Women's Health Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Women's Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; 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.