Shannon Kuettel, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

6320 W Union Hills Dr Ste A180
Glendale, AZ 85308-7153

Phone

(623) 748-8300

Fax

(623) 748-8314

NPI assigned

Aug 22, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon Olson Former name

Medicare fee-for-service enrollment

Enrolled in AZ

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

Physician Assistant

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.

• 4C Medical Group PLC

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1558654384
  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  AZ

  Medicare reassignment
• DM&a Holdings LLC

  • Chiropractor
  • Gilbert, AZ
  • NPI 1043068703
  NPD (past)

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503360000000",
    "number": "1124544051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 N 16TH ST APT 235",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164662",
            "telephone_number": "612-325-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 W UNION HILLS DR STE A180",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087153",
            "telephone_number": "623-748-8300",
            "fax_number": "623-748-8314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUETTEL",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-22",
        "last_updated": "2017-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "OLSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly Kruchowsky, P.T.
• Kim Krueger, RNC NNP
• Jessica Krupp
• Jaime Nicole Kubehl-Dykeman
• Cori Rae Kuest, RBT
• Katherine Christine Kuhlmann, CRNA, DNP
• Jamie Nicole Kuhn, OD
• Shirley Kuhn, PMHNP
• Kulbhushan K. Sharma MD, PC
• Kuleana Care (kuleana living)

• Medical Physician Assistant in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; 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.