Individual provider Active NPI

Shannon M York Conrey, APRN

  • Family Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1649294380
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN3180122 Issued in FL
Practice address
7381 College Pkwy Ste 110
Fort Myers, FL 33907-5527
Phone
(239) 482-1010
Fax
(239) 481-1481
NPI assigned
Jul 26, 2006
Last updated
Aug 25, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN3180122 FL Primary

Addresses

Primary practice location

7381 College Pkwy Ste 110
Fort Myers, FL 33907-5527

Mailing address

12730 New Brittany Blvd Ste 602
Fort Myers, FL 33907-4690
Phone (239) 275-5522

Other identifiers 2

IdentifierTypeStateIssuer
014116700MedicaidFL
Y0PT3OtherFLFLORIDA BLUE

Other names 1

  • Shannon York Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20150225001400 FL Practitioner - Nurse Practitioner 9739405325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

7381 College Pkwy
Suite 110
Fort Myers, FL 33907-5527
Phone (239) 482-1010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN3180122FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Primary Care of Southwest Florida PL CurrentSince Jan 5, 2015 Accepting new patients

Locations

1255 Viscaya Pkwy
Ste 200
Cape Coral, FL 33990
Phone (239) 574-1988

1265 Viscaya Pkwy
Cape Coral, FL 33990
Phone (239) 573-7337

12730 New Brittany Blvd
Ste 200
Fort Myers, FL 33907
Phone (239) 275-5857

12730 New Brittany Blvd
Ste 602
Fort Myers, FL 33907
Phone (239) 275-5522

13195 Metro Pkwy
Ste 8
Fort Myers, FL 33966
Phone (239) 482-1010

7381 College Pkwy
Ste 110
Fort Myers, FL 33907
Phone (239) 482-1010

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1649294380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12730 NEW BRITTANY BLVD STE 602",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074690",
            "telephone_number": "239-275-5522",
            "fax_number": "239-275-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7381 COLLEGE PKWY STE 110",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075527",
            "telephone_number": "239-482-1010",
            "fax_number": "239-481-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YORK CONREY",
        "first_name": "SHANNON",
        "middle_name": "M",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN3180122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014116700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "Y0PT3",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "YORK",
            "credential": "ARNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.