Fonda Kay Shaw, FNP/CNM

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP12989 Issued in CA

Practice address

5730 Packard Ave Ste 500
Marysville, CA 95901-7119

Phone

(530) 749-3242

Fax

(530) 767-1020

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fonda.shaw.p1@direct.peachtreehealth.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Peach Tree Healthcare

  • Federally Qualified Health Center (FQHC)
  • Marysville, CA
  • NPI 1003863622

  Nurse Practitioner

  Medicare reassignment NPD
• Peach Tree Healthcare

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1245043413
  NPD
• Peach Tree Healthcare

  • Federally Qualified Health Center (FQHC)
  • Yuba City, CA
  • NPI 1891454468
  NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1114038320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 YUBA ST STE 220",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959014838",
            "telephone_number": "530-749-3242",
            "fax_number": "530-743-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5730 PACKARD AVE STE 500",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959017119",
            "telephone_number": "530-749-3242",
            "fax_number": "530-767-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "FONDA",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "FNP/CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "1854",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP12989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Elizabeth-Eve Serna-Zimmerman, RN, PHN
• Michael Alexander Serpa
• Wade Michael Serrian
• Shivani Sharma
• Shannon Sharp
• Kaumakaokalani Shimatsu, M.D.
• Andrea Shively
• Moira Sibley
• David A Siesel, CRNA
• David Sean Silva

• Nurse Practitioner in Marysville, CA
• Providers in Marysville, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; 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.

Verify at the official NPI Registry.