Active NPI
Shannon Maclean, DO
- General Practice Physician
- Kirtland AFB, NM
National Provider Identifier
1376799817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- DR.0051993
- Practice address
- 2050A 2ND St SE
Kirtland AFB, NM 87117-1110 - Phone
- (253) 968-1110
- NPI assigned
- Aug 15, 2008
- Last updated
- Mar 29, 2021
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | DR.0051993 | CO | Primary |
Addresses
Primary practice location
2050A 2ND St SE
Kirtland AFB, NM 87117-1110
Mailing address
2050A 2ND St SE
Kirtland AFB, NM 87117-5522
Phone (505) 853-7992
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR.0051993 | CO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616976000000",
"number": "1376799817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050A 2ND ST SE",
"city": "KIRTLAND AFB",
"state": "NM",
"postal_code": "871175522",
"telephone_number": "505-853-7992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050A 2ND ST SE",
"city": "KIRTLAND AFB",
"state": "NM",
"postal_code": "871171110",
"telephone_number": "253-968-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACLEAN",
"first_name": "SHANNON",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-15",
"last_updated": "2021-03-29",
"certification_date": "2021-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CO",
"license": "DR.0051993",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirtland AFB, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.