Shannon Kay Waters, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

101692 Issued in NC

Practice address

322 Mulberry St SW
Suite a
Lenoir, NC 28645-5702

Phone

(828) 757-6460

Fax

(828) 759-4901

NPI assigned

Jun 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: swaters107772@direct.unc.nchie.net

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1538365184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 MULBERRY ST SW",
            "address_2": "SUITE A",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "286455702",
            "telephone_number": "828-757-6460",
            "fax_number": "828-759-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 MULBERRY ST SW",
            "address_2": "SUITE A",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "286455702",
            "telephone_number": "828-757-6460",
            "fax_number": "828-759-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "SHANNON",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-21",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "101692",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE NURSING LICENSE",
            "identifier": "081159",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "101692",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swaters107772@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "322 Mulberry St SW",
            "address_2": "Suite A",
            "city": "Lenoir",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286455702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jena Wallace
• Jesse Wallace, M.D.
• Sarah Wallace, LCAS-A
• Ian Walsh, PHARMD
• Ann Michelle Waters, FNP-BC
• Cristal McCall Watson, LPTA
• Haley Cheyenne Watson, FNP
• Valerie Hooper Watts, B.S, PHARM D, CPP
• Whitney Wellborn
• Wesley H. Bridges, D.D.S., P.a.

• Physician Assistant in Lenoir, NC
• Providers in Lenoir, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.

Verify at the official NPI Registry.