Active NPI
Kent Shelton
- Local Education Agency (LEA)
- San Manuel, AZ
National Provider Identifier
1063632347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Local Education Agency (LEA)
- License
- SLP0018
- Practice address
- 711 McNab Parkway and Main
San Manuel, AZ 85631 - Phone
- (520) 385-2337
- Fax
- (520) 385-2621
- NPI assigned
- Apr 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Local Education Agency (LEA) | 251300000X | SLP0018 | AZ | Primary |
Addresses
Primary practice location
711 McNab Parkway and Main
San Manuel, AZ 85631
Mailing address
711 McNab Parkway and Main
San Manuel, AZ 85631
Phone (520) 385-2337
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 |
|---|---|---|---|
| SLP0018 | AZ | MD | Local Education Agency (LEA) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mammoth-San Manuel Usd #8 | Local Education Agency (Lea) | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Local Education Agency (LEA)
- San Manuel, AZ
- NPI 1902936685
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063632347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 MCNAB PARKWAY AND MAIN",
"city": "SAN MANUEL",
"state": "AZ",
"postal_code": "85631",
"telephone_number": "520-385-2337",
"fax_number": "520-385-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 MCNAB PARKWAY AND MAIN",
"city": "SAN MANUEL",
"state": "AZ",
"postal_code": "85631",
"telephone_number": "520-385-2337",
"fax_number": "520-385-2621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELTON",
"first_name": "KENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "251300000X",
"taxonomy_group": "",
"desc": "Local Education Agency (LEA)",
"state": "AZ",
"license": "SLP0018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Manuel, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.