Naty Jane Demonteverde Shackelford, RN BSN, AG-ACNP

Primary specialty

Medical-Surgical Registered NurseTaxonomy code 163WM0705X

License

715619 Issued in TX

Practice address

13409 Georgia Hollow Court
Rosharon, TX 77583-2278

Phone

(281) 827-9689

NPI assigned

Nov 14, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1861037798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13409 GEORGIA HOLLOW COURT",
            "city": "ROSHARON",
            "state": "TX",
            "postal_code": "775832278",
            "telephone_number": "281-827-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13409 GEORGIA HOLLOW COURT",
            "city": "ROSHARON",
            "state": "TX",
            "postal_code": "775832278",
            "telephone_number": "281-827-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "NATY JANE",
        "middle_name": "DEMONTEVERDE",
        "name_prefix": "Mrs.",
        "credential": "RN BSN, AG-ACNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "TX",
            "license": "715619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical-Surgical Registered Nurse in Rosharon, TX
• Providers in Rosharon, TX by specialty
• Medical-Surgical Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.