Kandace Shoults, CRNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

1-074326 Issued in AL

Practice address

208 Pierson Ave
Centreville, AL 35042-2918

Phone

(205) 926-4881

NPI assigned

Oct 2, 2006

Last updated

Dec 3, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in AL

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

University of South Alabama College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Bibb County Healthcare AuthorityGroup PAC ID 7113822883, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• The Bibb County Healthcare Authority

  dba Bibb Medical Associates

  • Rural Health Clinic/Center
  • Centreville, AL
  • NPI 1972532299
  Medicare reassignment Care Compare group NPD
• The Bibb County Health Care Authority

  dba Bibb Medical Center Pharmacy

  • Pharmacy
  • Centreville, AL
  • NPI 1568558146
  NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1841383585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 PIERSON AVE",
            "city": "CENTREVILLE",
            "state": "AL",
            "postal_code": "350422918",
            "telephone_number": "205-926-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 PIERSON AVE",
            "city": "CENTREVILLE",
            "state": "AL",
            "postal_code": "350422918",
            "telephone_number": "205-926-4881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1768 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "AL",
            "postal_code": "367563406",
            "country_code": "US",
            "telephone_number": "334-683-9085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOULTS",
        "first_name": "KANDACE",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-074326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acute Care Nurse Practitioner in Centreville, AL
• Providers in Centreville, AL by specialty
• Acute Care Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.