Active NPI
Shannon Katheleen Terry
- Social Worker
- North Las Vegas, NV
National Provider Identifier
1003126095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 7911-M
- Practice address
- 5330 Edna Crane Ave
North Las Vegas, NV 89031-7989 - Phone
- (702) 741-1111
- NPI assigned
- Oct 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | |||
| Social Worker | 104100000X | 7911-M | NV | Primary |
Addresses
Primary practice location
5330 Edna Crane Ave
North Las Vegas, NV 89031-7989
Mailing address
5330 Edna Crane Ave
North Las Vegas, NV 89031-7989
Phone (702) 741-1111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7911-M | NV | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717113600000",
"number": "1003126095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5330 EDNA CRANE AVE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890317989",
"telephone_number": "702-741-1111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5330 EDNA CRANE AVE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890317989",
"telephone_number": "702-741-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TERRY",
"first_name": "SHANNON",
"middle_name": "KATHELEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-08",
"last_updated": "2024-05-31",
"certification_date": "2024-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NV",
"license": "7911-M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.