Active NPI
Tamara Jean Shannon, CPNP
- Pediatric Nurse Practitioner
- Albuquerque, NM
National Provider Identifier
1669446126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- CNP-01796
- Practice address
- 2211 Lomas Blvd NE
Albuquerque, NM 87106-2719 - Phone
- (505) 272-1221
- NPI assigned
- Feb 13, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | CNP-01796 | NM | Primary |
Addresses
Primary practice location
2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Mailing address
5540 Timberfalls Rd NW
Albuquerque, NM 87114-0594
Phone (505) 818-7958
Other practice location 1
377 Th Medical Group
Mdos/Sgomp
Kirtland AFB, NM 87117
Phone (505) 846-3701
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | UNMH@direct.health.unm.edu |
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)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP-01796 | NM | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687392000000",
"number": "1669446126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5540 TIMBERFALLS RD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871140594",
"telephone_number": "505-818-7958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 LOMAS BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062719",
"telephone_number": "505-272-1221"
}
],
"practiceLocations": [
{
"address_1": "377 Th Medical Group",
"address_2": "MDOS/SGOMP",
"address_purpose": "LOCATION",
"city": "Kirtland AFB",
"state": "NM",
"postal_code": "87117",
"country_code": "US",
"telephone_number": "505-846-3701",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHANNON",
"first_name": "TAMARA",
"middle_name": "JEAN",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-13",
"last_updated": "2023-06-22",
"certification_date": "2023-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "NM",
"license": "CNP-01796",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "UNMH@direct.health.unm.edu",
"affiliation": "N",
"address_1": "2211 Lomas Blvd NE",
"city": "Albuquerque",
"state": "NM",
"country_code": "US",
"postal_code": "871062719",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.