Active NPI
Shelley Cannon Frederick
- Art Therapist
- El Paso, TX
National Provider Identifier
1558072165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Art Therapist
- License
- 17-043
- Practice address
- 2496 Ricker Road
El Paso, TX 79916 - Phone
- (915) 742-9558
- Fax
- (915) 742-2363
- NPI assigned
- Dec 6, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Art Therapist | 221700000X | 17-043 | NC | Primary |
Addresses
Primary practice location
2496 Ricker Road
El Paso, TX 79916
Mailing address
2496 Ricker Road
El Paso, TX 79916
Phone (915) 742-9558
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17-043 | NC | MD | Art Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670284800000",
"number": "1558072165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2496 RICKER ROAD",
"city": "EL PASO",
"state": "TX",
"postal_code": "79916",
"telephone_number": "915-742-9558",
"fax_number": "915-742-2363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2496 RICKER ROAD",
"city": "EL PASO",
"state": "TX",
"postal_code": "79916",
"telephone_number": "915-742-9558",
"fax_number": "915-742-2363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "SHELLEY",
"middle_name": "CANNON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-12-06",
"last_updated": "2022-12-06",
"certification_date": "2022-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "221700000X",
"taxonomy_group": "",
"desc": "Art Therapist",
"state": "NC",
"license": "17-043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.