Active NPI
Shawnee Wilson, MA
- Other Technician
- Kayenta, AZ
National Provider Identifier
1487246617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 1029958
- Practice address
- 394.3 US-160
Kayenta, AZ 86033 - Phone
- (928) 697-4000
- NPI assigned
- Feb 9, 2021
- Last updated
- Feb 9, 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | 1029958 | NM | Primary |
Addresses
Primary practice location
394.3 US-160
Kayenta, AZ 86033
Mailing address
PO Box 405
Rock Point, AZ 86545-0405
Other practice location 1
Hwy 191, Hogan Circle Drive, Hs 461
Rock Point, AZ 86545
Phone (928) 550-0529
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1029958 | NM | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612828800000",
"number": "1487246617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 405",
"city": "ROCK POINT",
"state": "AZ",
"postal_code": "865450405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "394.3 US-160",
"city": "KAYENTA",
"state": "AZ",
"postal_code": "86033",
"telephone_number": "928-697-4000"
}
],
"practiceLocations": [
{
"address_1": "Hwy 191, Hogan Circle Drive, Hs 461",
"address_purpose": "LOCATION",
"city": "Rock Point",
"state": "AZ",
"postal_code": "86545",
"country_code": "US",
"telephone_number": "928-550-0529",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "SHAWNEE",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-09",
"last_updated": "2021-02-09",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "NM",
"license": "1029958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kayenta, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.