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NPI Code Detail

MEDICARE: MS. REBECCA DAWN SHATLEY

MEDICARE: MS. REBECCA DAWN SHATLEY
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
1363LF0000XFamily Nurse Practitioner076451NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
22592034DOTHERNCMEDICARE, INDIVIDUAL

Other Identifiers

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

General Provider Information

NPI Number : 1992723159
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. REBECCA DAWN SHATLEY
Provider Business Mailing Address
First Line : PO BOX 602658
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2658
Country : US
Telephone Number : 336-816-2011
Fax Number :
Provider Business Practice Location Address
First Line : 1900 W PARK DR
Second Line :
City : NORTH WILKESBORO
State : NC
Zip : 28659-3563
Country : US
Telephone Number : 336-903-6840
Fax Number : 336-903-6841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 07/21/2022

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Directions to “ MS. REBECCA DAWN SHATLEY ” Practice Location

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