Active NPI
Kelley C Shirron, NP
- Pediatric Nurse Practitioner
- Glenn Dale, MD
National Provider Identifier
1417250994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- AC000784
- Practice address
- 12150 Annapolis Rd
Suite 208
Glenn Dale, MD 20769-9183 - Phone
- (301) 218-0398
- NPI assigned
- Dec 6, 2010
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | AC000784 | MD | Primary |
Addresses
Primary practice location
12150 Annapolis Rd
Suite 208
Glenn Dale, MD 20769-9183
Mailing address
12150 Annapolis Rd
Suite 208
Glenn Dale, MD 20769-9183
Phone (301) 218-0398
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC000784 | MD | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Associates of Alexandria | Past | Accepting new patients |
Interoperability endpoints
- kelley.shirron@paa.eclinicaldirectplus.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatrics Physician
- Alexandria, VA
- NPI 1447358486
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323820800000",
"number": "1417250994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12150 ANNAPOLIS RD",
"address_2": "SUITE 208",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699183",
"telephone_number": "301-218-0398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12150 ANNAPOLIS RD",
"address_2": "SUITE 208",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699183",
"telephone_number": "301-218-0398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIRRON",
"first_name": "KELLEY",
"middle_name": "C",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-06",
"last_updated": "2011-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MD",
"license": "AC000784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenn Dale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.