Shannon Rose Hutton, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1912 Issued in NV

Practice address

2911 N Tenaya Way Ste 105
Las Vegas, NV 89128-0488

Phone

(702) 252-8378

NPI assigned

Jan 22, 2018

Last updated

Mar 17, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Aug 11, 2022 through Aug 11, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Ageless Men's Health NV, LLC

  • Urology Physician
  • Las Vegas, NV
  • NPI 1023330230
  NPD (past)
• Total Orthopedics LLC

  dba Ageless Men's Health

  • Multi-Specialty Clinic/Center
  • Henderson, NV
  • NPI 1447495858
  NPD (past)

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

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1598273708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 N TENAYA WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280464",
            "telephone_number": "702-252-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 N TENAYA WAY STE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280488",
            "telephone_number": "702-252-8378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTTON",
        "first_name": "SHANNON",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-22",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick McGuire Hutt, PT
• Victoria Hutt
• Stephanie E Hutto, RN
• Kiva S Hutton, LCSW
• Kristina Hutton, APRN
• Tiffany Hutton
• Yevgeniya Nikolayevna Hutton
• Huy Nguyen MD LTD
• Yip Huynh-Salameh, PHARMD
• Alan Tri Hao Huynh

• Physician Assistant in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.