Active NPI
Shannon Douglas, FNP
- Family Nurse Practitioner
- Hamilton, OH
National Provider Identifier
1679920466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- COA.19029-NP
- Practice address
- 543 Park Ave
Hamilton, OH 45013-3033 - Phone
- (513) 737-0257
- NPI assigned
- May 21, 2016
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | COA.19029-NP | OH | Primary |
Addresses
Primary practice location
543 Park Ave
Hamilton, OH 45013-3033
Mailing address
543 Park Ave
Hamilton, OH 45013-3033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211021002627 | OH | Order and Referring Only - Nurse Practitioner | 7012305105 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA.19029-NP | OH | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463788800000",
"number": "1679920466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "543 PARK AVE",
"city": "HAMILTON",
"state": "OH",
"postal_code": "450133033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "543 PARK AVE",
"city": "HAMILTON",
"state": "OH",
"postal_code": "450133033",
"telephone_number": "513-737-0257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "SHANNON",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-21",
"last_updated": "2016-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "COA.19029-NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hamilton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.