NPIMap

Organization Active NPI

Shannon Kersey, Lpa

  • Clinical Child & Adolescent Psychologist
  • Charlotte, NC
National Provider Identifier
1164708228
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
2531 Issued in NC
Legal business name
SHANNON KERSEY, LPA
Practice address
4425 Randolph Rd
Suite 208
Charlotte, NC 28211-2351
Phone
(704) 323-6586
NPI assigned
Nov 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Authorized official

Name
Ms. Shannon KerseyNPI 1720190234
Title
Sole Proprietor
Phone
(704) 323-6586

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC2200X 2531 NC Primary

Addresses

Primary practice location

4425 Randolph Rd
Suite 208
Charlotte, NC 28211-2351

Mailing address

4425 Randolph Rd
Suite 208
Charlotte, NC 28211-2351

National Provider Directory

National Provider Directory

Locations

4425 Randolph Rd
Ste 208
Charlotte, NC 28211
Phone (704) 323-6586

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1164708228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 RANDOLPH RD",
            "address_2": "SUITE 208",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 RANDOLPH RD",
            "address_2": "SUITE 208",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112351",
            "telephone_number": "704-323-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON KERSEY, LPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-02",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "KERSEY",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "704-323-6586",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "2531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.