Susan Ashley Shively, CRNFA, MSN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3004973 Issued in KY

Practice address

803 Lebanon Ave
Campbellsville, KY 42718-1809

Phone

(270) 465-2521

NPI assigned

Jan 19, 2007

Last updated

Apr 28, 2011By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: sshively@direct-address.org

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.

• Central Kentucky Surgical Services LLC

  • Nurse Practitioner
  • Campbellsville, KY
  • NPI 1689701997
  Authorized official Same address or phone

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303948800000",
    "number": "1972656379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 LEBANON AVE",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427181809",
            "telephone_number": "270-465-2521",
            "fax_number": "270-789-1756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 LEBANON AVE",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427181809",
            "telephone_number": "270-465-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "SUSAN",
        "middle_name": "ASHLEY",
        "name_prefix": "Mrs.",
        "credential": "CRNFA, MSN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2011-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3004973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100001600",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Rose Shepperd, APRN
• Linda K Shipp, RPH
• Samantha Shipp
• Eugene Herman Shively, M.D.
• Laree Shively, APRN
• Gail Shofner
• Lyndsie Short, ATC
• Barbara Natalie Shuffett, APRN
• Beverly Lynne Shuffett, MSSW, LCADC
• Tonja Denise Simpson

• Family Nurse Practitioner in Campbellsville, KY
• Providers in Campbellsville, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; 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.