Rebecca Dawn Shatley

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

076451 Issued in NC

Practice address

1900 W Park Dr
North Wilkesboro, NC 28659-3563

Phone

(336) 903-6840

Fax

(336) 903-6841

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1992723159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602658",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602658",
            "telephone_number": "336-816-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 W PARK DR",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593563",
            "telephone_number": "336-903-6840",
            "fax_number": "336-903-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATLEY",
        "first_name": "REBECCA",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "076451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7003694",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE, INDIVIDUAL",
            "identifier": "2592034D",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane T. Ryder, LPA
• William Kenneth Sanders
• William J Scarpa Jr., MD
• Shirley Jane Scharett, CADC
• Marie C Schindler
• Tracey Elledge Sheets, FNP-C
• Ashley Anna Shell
• Robyn Shelton, MS, OTR/L
• Donna Grasmehr Shew
• Willard Jeffrey Shew, CRNA

• Family Nurse Practitioner in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.