Individual provider Active NPI

Makayla Shea, LPN

  • Licensed Practical Nurse
  • Warren, OH
National Provider Identifier
1639748874
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
172085 Issued in OH
Practice address
4930 Enterprise Dr NW
Warren, OH 44481-8706
Phone
(330) 787-0955
NPI assigned
Jun 22, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 172085 OH Primary

Addresses

Primary practice location

4930 Enterprise Dr NW
Warren, OH 44481-8706

Mailing address

4930 Enterprise Dr NW
Warren, OH 44481-8706
Phone (330) 787-0955

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

LicenseStateTypeSpecialty
172085OHMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
FSR of Parkman LLC CurrentSince Sep 18, 2024 Accepting new patients

Locations

4930 Enterprise Dr NW
Warren, OH 44481
Phone 3303698022 ext. 153

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/parkmanrecovery/r4/

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": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1639748874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 ENTERPRISE DR NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444818706",
            "telephone_number": "330-787-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 ENTERPRISE DR NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444818706",
            "telephone_number": "330-787-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "MAKAYLA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "172085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.