Kaitlyn M Shaughnessy, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14694-24 Issued in WI

Practice address

49 MDG
280 David L. Goldfein St, BLDG 23
Holloman Afb, NM 88330

Phone

(575) 572-8860

NPI assigned

Jul 9, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1255983417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 MDG",
            "address_2": "280 DAVID L. GOLDFEIN ST, BLDG 23, HOLLOMAN AFB",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "88330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 MDG",
            "address_2": "280 DAVID L. GOLDFEIN ST, BLDG 23",
            "city": "HOLLOMAN AFB",
            "state": "NM",
            "postal_code": "88330",
            "telephone_number": "575-572-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAUGHNESSY",
        "first_name": "KAITLYN",
        "middle_name": "M",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14694-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob P Sanders, ARNP/DNP
• Jo Ann Schroeder, C.N.P.
• Mayra Serrano
• Shevina Yvette Session, LVN
• Tarek Shabany, D.D.S.
• Jessica Nicole Simmons, PHARMD
• John Francis Skicki, PSY.D.
• Andrew Smietana, DPT
• Debra Ann Smith, RNC, MS, WHNP
• Ericka Renee Smith, DA 3160

• Physical Therapist in Holloman Afb, NM
• Providers in Holloman Afb, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.