Shadara King, AGNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5011293 Issued in NC

Practice address

3214 Charles B Root Wynd Ste 203
Raleigh, NC 27612-5440

Phone

(919) 877-6800

Fax

(844) 881-7701

NPI assigned

Dec 17, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Other names 1

• Shadara Edmond Former name

Medicare fee-for-service enrollment

Enrolled in NC, DE2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eclipse Wellness LLC

  • Pain Medicine Physician
  • Wilmington, DE
  • NPI 1245992262

  Single Specialty

  Medicare reassignment NPD
• Strive Health PA, LLC

  • Nephrology Physician
  • Denver, CO
  • NPI 1841817921
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1093286015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 TIMBER WOLF XING",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275299279",
            "telephone_number": "302-228-6434",
            "fax_number": "910-348-7961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3214 CHARLES B ROOT WYND STE 203",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125440",
            "telephone_number": "919-877-6800",
            "fax_number": "844-881-7701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6000 Poplar Ave Ste 250",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381193974",
            "country_code": "US",
            "telephone_number": "901-625-5408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3508 Market St Ste 213",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191043320",
            "country_code": "US",
            "telephone_number": "267-754-8400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "SHADARA",
        "name_prefix": "Mrs.",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-17",
        "last_updated": "2023-07-07",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LP-0010645",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "33592",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "27576",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "3-001270",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5011293",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "AG03180040",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5011293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHADARA",
            "last_name": "EDMOND",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Megan King
• Michael Lawrence King, DMD
• Monica King
• Roshana King
• Sarah King
• Shae King
• Shelby Elizabeth King, M.S.ED, BCBA
• Sierra King
• Kingdom Deliveries LLC
• Kingdom Transportation, Inc.

• Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.