JENNIFER ANNE SHATTUCK (NPI# 1023032729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023032729 |
| Entity Type | Individual |
| Full Name | JENNIFER ANNE SHATTUCK |
| Credential | N.P. |
| Practice Address |
260 Riverside Dr Johnson City NY 13790-2745 |
| Practice Telephone | 6077987811 |
| Mailing Telephone | 6077987811 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
334772 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02742863 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386920304 | Jennifer Shattuck | Registered Nurse | 108 Education Dr, Mpms Room 127, Schenectady, NY 12303-1238 | 2011-10-24 |
| 1104807957 | Jennifer Shattuck | Nurse Anesthetist, Certified Registered | 1638 Owen Dr, Fayetteville, NC 28304-3424 | 2005-11-09 |
| Street Address |
260 RIVERSIDE DR |
| City | JOHNSON CITY |
| State | NY |
| Zip Code | 13790-2745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669463691 | Asha Gupta | Allergy & Immunology | 260 Riverside Dr, Johnson City, NY 13790-2727 | 2005-10-31 |
| 1063828374 | Riverbend Family Dental | Dentist | 260 Riverside Dr, Johnson City, NY 13790-2745 | 2014-07-08 |
| 1346677366 | Christina Waiculonis | Physician Assistant | 260 Riverside Dr, Johnson City, NY 13790-2798 | 2013-10-04 |
| 1063662930 | David A. Rogers | Dentist | 260 Riverside Dr, Johnson City, NY 13790 | 2008-09-26 |
| 1699961185 | Asha Gupta, Md | Allergy & Immunology | 260 Riverside Dr, Johnson City, NY 13790-2745 | 2007-09-19 |
| 1417141607 | Barret T J. Raff,dds | Dentist | 260 Riverside Dr, Johnson City, NY 13790-2745 | 2007-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578107645 | Thomas William Sorber | Occupational Therapist | 33 Harrison St, Johnson City, Johnson City, NY 13790 | 2019-11-01 |
| 1326534116 | Silver Linings Golden Memory Care | Clinic/Center | 4416 Watson Blvd, Johnson City, NY 13790 | 2018-07-05 |
| 1508308545 | Irene Mukeli Nzasi | Registered Nurse | 156 Corliss Ave Suite 107, Johnson City, NY 13790 | 2016-11-08 |
| 1053867754 | Tabitha Rae Toman | Physical Therapist | 34 Harrison St, Johnson City, NY 13790 | 2016-09-01 |
| 1235685066 | Dianne Brunner | Physical Therapist | 33-55 Harrison Street, Wilson Hospital, Johnson City, NY 13790 | 2016-08-31 |
| 1578982682 | Tracy Lynn Brown | Optometrist | 223 Reynolds Road, Johnson City, NY 13790 | 2014-04-16 |
| 1083041495 | Maryann Serbonich | Pharmacist | 52 Harrison Street, Johnson City, NY 13790 | 2013-09-30 |
| 1134464399 | Kasey Connor Folger | Speech-Language Pathologist | 3 Laurel St., Johnson City, NY 13790 | 2012-11-29 |
| 1467797571 | Bodyworks Physical Therapy LLC | Clinic/Center | 765 Harry L Drive, Johnson City, NY 13790 | 2012-11-29 |
| 1548518400 | Melissa L Korosec | Nurse Practitioner | 30 Harrison St., Suite 250, Johnson City, NY 13790 | 2012-08-27 |
| Find all providers in zip 13790 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063025724 | Victoria Elizabeth Mcmanus | Nurse Practitioner | 365 Harry L Dr Ste 110, Johnson City, NY 13790-1471 | 2020-08-24 |
| 1649880139 | Amanda Danielle Ledford | Nurse Practitioner | 3 Enfield Ct, Johnson City, TN 37604-9101 | 2020-08-09 |
| 1861000135 | Deborah L Johnson | Nurse Practitioner | 2 Mcgregor Pl, Johnson City, TN 37604-1454 | 2020-07-22 |
| 1255978417 | William Mcguire | Nurse Practitioner | 176 Willocks Rd, Johnson City, TN 37601-6274 | 2019-12-06 |
| 1881248664 | Caiti Riden | Nurse Practitioner | 316 Marketplace Dr Ste 10, Johnson City, TN 37604-2595 | 2019-07-30 |
| 1699330282 | Courtney S Willis | Nurse Practitioner | 2203 N Greenwood Dr, Johnson City, TN 37604-7030 | 2019-05-08 |
| 1861955452 | Cindy Canter | Nurse Practitioner | 3552 Greenwood Dr, Johnson City, TN 37604-2834 | 2019-04-10 |
| 1366908980 | Holly Anne Parvin | Nurse Practitioner | 3209 W Walnut St, Johnson City, TN 37604-5949 | 2019-02-19 |
| 1891261376 | Lindsey Toney | Nurse Practitioner | 980 Smalling Rd, Johnson City, TN 37601-8208 | 2018-10-22 |
| 1821572868 | Karyn Kimberly Bruton | Nurse Practitioner | 1723 N Roan St, Johnson City, TN 37601-3949 | 2018-09-15 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 13790 |
Please comment or provide details below to improve the information on JENNIFER ANNE SHATTUCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.