Active NPI
Shannon Amy Kloosterman, TECHNICIAN
- Technician/Technologist
- Ashland, VA
National Provider Identifier
1225515083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician/Technologist
- License
- 24915
- Practice address
- 9714 Sliding Hill Rd
Ashland, VA 23005-7940 - Phone
- (252) 673-7736
- NPI assigned
- Jul 25, 2018
- Last updated
- Jul 25, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Technician/Technologist | 156F00000X | 24915 | NC | Primary |
Addresses
Primary practice location
9714 Sliding Hill Rd
Ashland, VA 23005-7940
Mailing address
9714 Sliding Hill Rd
Ashland, VA 23005-7940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24915 | NC | MD | Technician/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532476800000",
"number": "1225515083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9714 SLIDING HILL RD",
"city": "ASHLAND",
"state": "VA",
"postal_code": "230057940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9714 SLIDING HILL RD",
"city": "ASHLAND",
"state": "VA",
"postal_code": "230057940",
"telephone_number": "252-673-7736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOOSTERMAN",
"first_name": "SHANNON",
"middle_name": "AMY",
"credential": "TECHNICIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-25",
"last_updated": "2018-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "156F00000X",
"taxonomy_group": "",
"desc": "Technician/Technologist",
"state": "NC",
"license": "24915",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ashland, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.