Shannon Rea Davis, NP-C , PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

148870 Issued in AK

Practice address

17051 Mercy Dr Ste 204
Eagle River, AK 99577-7630

Phone

(907) 696-0096

Fax

(949) 577-4808

NPI assigned

Oct 30, 2014

Last updated

Mar 2, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, AK, MT3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of Alaska Department of AdministrationGroup PAC ID 5395638571, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• State of Alaska Department of Administration

  dba Alaska Psychiatric Institute

  • Psychiatric Hospital
  • Anchorage, AK
  • NPI 1497842553
  Medicare reassignment Care Compare group NPD
• Tranquility Behavioral Telehealth LLC

  dba Glacier Mental and Family Health Solutions

  • Psychiatric/Mental Health Nurse Practitioner
  • Eagle River, AK
  • NPI 1306488572

  Family, MT, TN

  Medicare reassignment NPD Authorized official
• App of Tennessee Ed, PLLC

  • Emergency Medicine Physician
  • Maryville, TN
  • NPI 1003230236

  Nurse Practitioner

  Medicare reassignment NPD
• Southeastern Emergency Services P C

  • Nurse Practitioner
  • Athens, TN
  • NPI 1669414264
  Medicare reassignment NPD
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  Nurse Practitioner

  Medicare reassignment NPD
• Victoria Emergency Partners LLC

  • Emergency Medicine Physician
  • Gonzales, TX
  • NPI 1164770996
  NPD
• Abk Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Alice, TX
  • NPI 1801983036

  Nurse Practitioner

  NPD (past)
• Boone County Hospital

  • Critical Access Hospital
  • Boone, IA
  • NPI 1467434225
  NPD (past)
• Chest Diagnostic Therapeutic SVCS & Transit Nursing of TX, Inc

  dba Chest Diagnostic Therapeutic Services, Inc

  • Durable Medical Equipment & Medical Supplies
  • Mexia, TX
  • NPI 1770589392
  NPD (past)
• Tri County Family Medical Care Group LLC

  • Family Medicine Physician
  • Mexia, TX
  • NPI 1174926554
  NPD (past)

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709337600000",
    "number": "1508261702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772852",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995772852",
            "telephone_number": "907-696-0096",
            "fax_number": "949-577-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 MERCY DR STE 204",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777630",
            "telephone_number": "907-696-0096",
            "fax_number": "949-577-4808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18 W Mercer St Ste 360",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981193993",
            "country_code": "US",
            "telephone_number": "907-969-0096",
            "fax_number": "949-577-4808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Central Ave Ste 208",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "594013141",
            "country_code": "US",
            "telephone_number": "907-696-0096",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "SHANNON",
        "middle_name": "REA",
        "credential": "NP-C , PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-30",
        "last_updated": "2024-03-02",
        "certification_date": "2024-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "21452",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "148870",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61119130",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "243410",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MT",
            "license": "233985",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202105062NPPP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AK",
            "license": "148870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Barbara Phan Dana, FNP
• Mandolin Faith Daniels
• Rachel Stephenson Daniels, PT, DPT
• David E Frankl
• Donna Klokkevold Davidson, P.T.
• Janet Daw, LPC
• Briana Dawson
• Lauren Granier Dean, OTR/L
• Eldon Lee Dekay, DMD
• Juliane Delozier

• Psychiatric/Mental Health Nurse Practitioner in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.