MEDICARE: NICOLE E SHUTTS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2003003739	MO
2	363LF0000X	Family Nurse Practitioner	793067	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023251535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE E SHUTTS FNP-C

Provider Business Mailing Address
First Line	:	3100 MCKINNON ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 MCKINNON ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1044
Country	:	US
Telephone Number	:	866-377-7595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	09/12/2012

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Directions to “ NICOLE E SHUTTS FNP-C” Practice Location

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