Individual provider Active NPI

Sharon A. McKenna, D.O.

  • Family Medicine Physician
  • Henderson, NV
National Provider Identifier
1497705222
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2418 Issued in NV
Practice address
874 American Pacific Dr
Henderson, NV 89014-8800
Phone
(702) 777-4809
Fax
(702) 777-4822
NPI assigned
May 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2418 NV Primary
Family Medicine Physician 207Q00000X OS12638 FL

Addresses

Primary practice location

874 American Pacific Dr
Henderson, NV 89014-8800

Mailing address

1801 W Olympic Blvd # 2265
Pasadena, CA 91199-0001

Other practice location 1

12780 Race Track Rd
Suite 300
Tampa, FL 33626-1395
Phone (813) 792-9541

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181214000777 NV Practitioner - Family Practice 6608969100 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2418NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Touro University Family Medicine CurrentSince Aug 22, 2018 Accepting new patients

Locations

1801 W Olympic Blvd
#2265
Pasadena, CA 91199

874 American Pacific Dr
Henderson, NV 89014
Phone (702) 777-4808

Interoperability endpoints

  • Direct secure messaging: sharonmckenna@tu.allscriptsdirect.net

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1497705222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W OLYMPIC BLVD # 2265",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911990001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 AMERICAN PACIFIC DR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890148800",
            "telephone_number": "702-777-4809",
            "fax_number": "702-777-4822"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12780 Race Track Rd",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336261395",
            "country_code": "US",
            "telephone_number": "813-792-9541",
            "fax_number": "813-443-8170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "SHARON",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "2418",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS12638",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.