MISS COURTNEY NICOLE SHAFFER PA-C
NPI 1093209041
Physician Assistant - Surgical in Kokomo, IN

Active since June 21, 2018PECOS EnrolledAccepts Medicare Assignment
1907 W SYCAMORE ST # 200, KOKOMO, IN 46901(765) 236-8170 Get Directions Write a Review

NPPES record last updated: August 9, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Aug 9, 2024, Aug 15, 2022, Feb 28, 2022 and 3 more (6 updates tracked since 2018).

About Miss Courtney Nicole Shaffer Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS COURTNEY NICOLE SHAFFER PA-C (NPI 1093209041) is an individual surgical provider in Kokomo, Indiana, licensed in Indiana (10002483A) and active in the NPI registry since June 2018. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1093209041
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameMISS COURTNEY NICOLE SHAFFERCredential: PA-C
Location Address1907 W SYCAMORE ST # 200Kokomo, IN 46901-5148
Mailing Address1907 W Sycamore St # 200Kokomo, IN 46901-5148
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateJune 21, 2018
Last NPPES UpdateAugust 9, 20246 updates tracked since enumeration
NPPES CertifiedAugust 9, 2024
NPI 1093209041 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License Licensed in IN · 10002483A
1907 W SYCAMORE ST # 200, Kokomo, IN 46901

Secondary Practice Locations 2

Location 11101 Michigan AveLogansport, IN 46947 · Phone (574) 753-7541
Location 22485 E Wabash StFrankfort, IN 46041-9400 · Phone (765) 236-8170

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Miss Courtney Nicole Shaffer Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9830446608
PECOS Enrollment IDI20180725000905
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Orthopaedic Surgery
1907 W SYCAMORE ST # 200
KOKOMO, IN 46901

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1093209041, enumerated as an "individual" on June 21, 2018.

The provider is located at 1907 W SYCAMORE ST # 200 KOKOMO, IN 46901 and the phone number is (765) 236-8170.

Physician Assistant with taxonomy code 363AS0400X and a focus in Surgical.

The provider might be accepting Accepts: Ambetter from Buckeye Health Plan, Ambetter from. Please consult your insurance carrier or call the provider to verify.