Active NPI
Shannon Rei Kleckner, PHDHP
- Dental Hygienist
- Erie, PA
National Provider Identifier
1265837850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- PHDH000618
- Practice address
- 606 W 2ND St
Erie, PA 16507-1111 - Phone
- (814) 451-6700
- Fax
- (814) 451-6766
- NPI assigned
- Oct 26, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | PHDH000618 | PA | Primary |
Addresses
Primary practice location
606 W 2ND St
Erie, PA 16507-1111
Mailing address
606 W 2ND St
Erie, PA 16507-1111
Phone (814) 451-6700
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 |
|---|---|---|---|
| PHDH000618 | PA | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Erie | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Public Health or Welfare Agency
- Erie, PA
- NPI 1235355793
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414281600000",
"number": "1265837850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "606 W 2ND ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165071111",
"telephone_number": "814-451-6700",
"fax_number": "814-451-6766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 W 2ND ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165071111",
"telephone_number": "814-451-6700",
"fax_number": "814-451-6766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLECKNER",
"first_name": "SHANNON",
"middle_name": "REI",
"name_prefix": "Ms.",
"credential": "PHDHP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-26",
"last_updated": "2014-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "PA",
"license": "PHDH000618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.