Active NPI
Kelly Shook, PA
- Physician Assistant
- Austin, TX
National Provider Identifier
1336363381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA04675
- Practice address
- 4303 Victory Dr
Austin, TX 78704-8870 - Phone
- (512) 462-3627
- Fax
- (512) 462-3431
- NPI assigned
- Apr 12, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA04675 | TX | Primary |
Addresses
Primary practice location
4303 Victory Dr
Austin, TX 78704-8870
Mailing address
4303 Victory Dr
Austin, TX 78704-8870
Phone (512) 462-3627
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA04675 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257897600000",
"number": "1336363381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4303 VICTORY DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787048870",
"telephone_number": "512-462-3627",
"fax_number": "512-462-3431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4303 VICTORY DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787048870",
"telephone_number": "512-462-3627",
"fax_number": "512-462-3431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOOK",
"first_name": "KELLY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2009-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA04675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.