NPI age
15 years
Enumerated 2011-01-28
● Active
Type 1 · Individual
MS. Kerry Kathleen Shuffelbottom, PA-C
Shuffelbottom is 1 of 13 physician assistant providers in Pooler and 1 of 4616 in Georgia.
Primary specialty
Physician Assistant
Plus 1 subspecialty
Licensed in
SC
1 state
Status
Active
No deactivations on record
Last NPPES update
2023-10-12
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 4616 active physician assistant providers in Georgia.
NPI age
15 years
↑ 7 yr above median (8 yr)
State licenses
1 state
9% of peers hold multiple states
Subspecialties
1
In the 24% of peers with subspecialties
NPI lifetime · 2011 → 2026
2011-01Enumerated in NPPES
2011
2026
Where they practice
Practice location
200 Blue Moon Xing Ste 203
Pooler, GA 313229698
Mailing address
5191 First Coast Tech Pkwy Fl 3
Jacksonville, FL 322240609
Additional practice locations
1 secondary location on file with NPPES.
Location 2
3408 Trout St
Brunswick, GA 315203622
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
-
Physician AssistantDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (FL) | Y06PS | BCBS |
| 05 (FL) | 0032613-00 |
Practice context
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
Recently enumerated nearby: 1 new physician assistant provider has been added in Pooler in the last 180 days.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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