Active NPI
Shannon Kenney, DO
- Family Medicine Physician
- Augusta, ME
National Provider Identifier
1053390690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1836
- Practice address
- 1 VA Ctr
Department of Veterans Affairs
Augusta, ME 04330-6719 - Phone
- (207) 623-8411
- Fax
- (207) 621-4844
- NPI assigned
- Jan 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1836 | ME | Primary |
Addresses
Primary practice location
1 VA Ctr
Department of Veterans Affairs
Augusta, ME 04330-6719
Mailing address
1 VA Ctr
Department of Veterans Affairs
Augusta, ME 04330-6719
Phone (207) 623-8411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121019000497 | ME | Order and Referring Only - Family Practice | 6305818402 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1836 | ME | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301356800000",
"number": "1053390690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 VA CTR",
"address_2": "DEPARTMENT OF VETERANS AFFAIRS",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043306719",
"telephone_number": "207-623-8411",
"fax_number": "207-621-4844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 VA CTR",
"address_2": "DEPARTMENT OF VETERANS AFFAIRS",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043306719",
"telephone_number": "207-623-8411",
"fax_number": "207-621-4844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEY",
"first_name": "SHANNON",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-12",
"last_updated": "2011-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "1836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, ME
- Kennebec Valley Family Dentistry
- Kennebec Valley Obstetrics & Gynecology
- Kennebec Valley Radiology Professional Association
- Rosemarie Kenney-Lavin, F.N.P.
- Ellen J Kenney, RPH, PHARM.D.
- Patricia Ann Keohan, NP
- Shaista Khanum, MD
- Sara Beth Kheboian, PHARMD
- Joan Kheder, M.D.
- James Willliam Kidwell, MSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.