Shannon Nikkole Kemp

Key facts

NPI

1497480396

Entity type

Individual (NPI type 1)

Primary specialty

Acute Care Nurse Practitioner 363LA2100X

License

1-32286 (AL)

Practice address

2690 Hawthorne Lake Rd
Helena, AL 35022-7215

Phone

(205) 223-5242

NPI assigned

Jul 24, 2022

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Community Care Health Network LLC Nurse Practitioner · Nashville, TN · NPI 1619368842
  Medicare reassignment NPD GA
• Wellstar Medical Group, LLC Family Medicine Physician · Kennesaw, GA · NPI 1558664003
  Medicare reassignment NPD GA
• Wellstar Medical Group, LLC Multi-Specialty Clinic/Center · Marietta, GA · NPI 1275992240
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 24, 2022.

{
    "created_epoch": "1658620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658620800000",
    "number": "1497480396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 HAWTHORNE LAKE RD",
            "city": "HELENA",
            "state": "AL",
            "postal_code": "350227215",
            "telephone_number": "205-223-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2690 HAWTHORNE LAKE RD",
            "city": "HELENA",
            "state": "AL",
            "postal_code": "350227215",
            "telephone_number": "205-223-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEMP",
        "first_name": "SHANNON",
        "middle_name": "NIKKOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-24",
        "last_updated": "2022-07-24",
        "certification_date": "2022-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-32286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Helena, AL · Acute Care Nurse Practitioner in Alabama