Active NPI
Briana Amber Shackley, RDH
- Dental Hygienist
- Emmett, ID
National Provider Identifier
1932963295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH-4447
- Practice address
- 1020 E Locust St
Emmett, ID 83617-2776 - Phone
- (208) 365-5064
- Fax
- (208) 865-1659
- NPI assigned
- Feb 7, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH-4447 | ID | Primary |
Addresses
Primary practice location
1020 E Locust St
Emmett, ID 83617-2776
Mailing address
12671 W Endsley LN
Star, ID 83669-1019
Phone (208) 608-6329
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DH-4447 | ID | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707264000000",
"number": "1932963295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12671 W ENDSLEY LN",
"city": "STAR",
"state": "ID",
"postal_code": "836691019",
"telephone_number": "208-608-6329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 E LOCUST ST",
"city": "EMMETT",
"state": "ID",
"postal_code": "836172776",
"telephone_number": "208-365-5064",
"fax_number": "208-865-1659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKLEY",
"first_name": "BRIANA",
"middle_name": "AMBER",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-07",
"last_updated": "2024-02-07",
"certification_date": "2024-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "ID",
"license": "DH-4447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Emmett, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.