Shannon Elizabeth Hamilton, PA
Individual provider Active NPI Physician Assistant · Manchester, MO
NPI 1164713632 · NPPES record last updated Oct 12, 2022
Key facts
- NPI
- 1164713632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2011011827 (MO)
- Practice address
- 409 Lafayette Ctr
Manchester, MO 63011-3943 - Phone
- (636) 707-0764
- NPI assigned
- May 2, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110602000567 | MO | Practitioner - Physician Assistant | 2769669522 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011011827 | MO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America LLC | Current |
Accepting new patients | |
| Cep America LLC | Current |
Accepting new patients | |
| Coastal Wound Physicians | Past |
Accepting new patients |
Locations
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000
6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2011011827 | MO | Yes |
Addresses
Primary practice location
409 Lafayette Ctr
Manchester, MO 63011-3943
Mailing address
409 Lafayette Ctr
Manchester, MO 63011-3943
Phone (636) 707-0764
Other practice location 1
3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone (314) 996-5225
Other providers in Manchester, MO
- Rieko T Griffin
- Guarantee Medical Supply Company LLC
- Emily Haffner
- Avery Hagedorn
- Thomas H Hale
- Susan Irene Hanlon
- Stetson Hanning
- Cathleen Hardin
- Stephen Edward Haring
- Fizza Hassan
All providers in Manchester, MO · Physician Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.