NPIMap

Individual provider Active NPI

Shelby Marie Eastin, FNP-BC

  • Family Nurse Practitioner
  • Lakewood, WA
National Provider Identifier
1992566806
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61526448 Issued in WA
Practice address
11311 Bridgeport Way SW Ste 207
Lakewood, WA 98499-3051
Phone
(253) 272-8664
Fax
(253) 627-7880
NPI assigned
Jan 17, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AP61526448 WA
Family Nurse Practitioner 363LF0000X 28251063C IN
Family Nurse Practitioner 363LF0000X AP61526448 WA Primary

Addresses

Primary practice location

11311 Bridgeport Way SW Ste 207
Lakewood, WA 98499-3051

Mailing address

6044 Yosemite Dr
Newburgh, IN 47630-2005
Phone (618) 335-1536

Other identifiers 1

IdentifierTypeStateIssuer
2280338MedicaidWA

Other names 1

  • Shelby M Burroughs Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address seastin855021@fhsce.catholichealth.net Direct Franciscan Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240517003125 WA Practitioner - Nurse Practitioner 3577904796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

11311 Bridgeport Way SW
Suite 207
Lakewood, WA 98499-3051
Phone (253) 272-8664

Hospital & facility affiliations

  • St Clare Hospital Hospital, Lakewood, WA, CCN 500021
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • St Francis Community Hospital Hospital, Federal Way, WA, CCN 500141
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28251063CINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group CurrentSince Apr 15, 2024 Accepting new patients
Franciscan Medical Group CurrentSince Apr 15, 2024 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group Past Accepting new patients

Locations

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

11311 Bridgeport Way SW
Ste 207
Tacoma, WA 98499

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1992566806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6044 YOSEMITE DR",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302005",
            "telephone_number": "618-335-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11311 BRIDGEPORT WAY SW STE 207",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984993051",
            "telephone_number": "253-272-8664",
            "fax_number": "253-627-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EASTIN",
        "first_name": "SHELBY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "AP61526448",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28251063C",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61526448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2280338",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "seastin855021@fhsce.catholichealth.net",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11311 Bridgeport Way SW Ste 207",
            "city": "Lakewood",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984993051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "BURROUGHS",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.