Shaun Rebecca Edwards, APRN
Individual provider Active NPI Primary Care Nurse Practitioner · Crescent City, CA
NPI 1679957609 · NPPES record last updated Apr 2, 2025
Key facts
- NPI
- 1679957609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 79150 (OK)
- Practice address
- 550 E Washington Blvd Ste 100
Crescent City, CA 95531-8161 - Phone
- (707) 465-6925
- Fax
- (707) 387-9808
- NPI assigned
- Jul 20, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Open Door Community Health Centers
Practice addresses (Care Compare)
550 E Washington Blvd
Crescent City, CA 95531-8160
Phone (707) 465-6925
Hospital & facility affiliations
- Sutter Coast Home Care
- Sutter Coast Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in OK, TX, CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150902001287 | OK | Practitioner - Nurse Practitioner | 2769798917 | Reassigns benefits to 1 organization |
| I20210614001869 | TX | Practitioner - Nurse Practitioner | 2769798917 | Reassigns benefits to 1 organization |
| I20260303001971 | CA | Practitioner - Nurse Practitioner | 2769798917 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Choctaw Nation of Oklahoma | Current |
Accepting new patients | |
| Choctaw Nation of Oklahoma | Current | Accepting new patients | |
| Choctaw Nation of Oklahoma | Current |
Accepting new patients | |
| Integris Ambulatory Care Corporation | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients |
Locations
550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636
550 E Washington Blvd
Ste 100
Crescent City, CA 95531
Phone (707) 465-6925
1585 W Liberty Rd
Atoka, OK 74525
Phone (580) 889-1981
1300 E Martin Luther King Dr
Broken Bow, OK 74728
Phone (580) 208-2204
401 S 3rd St
Enid, OK 73701
Phone (580) 548-1112
410 N M St
Hugo, OK 74743
Phone (580) 326-7561
902 E Lincoln Rd
Idabel, OK 74745
Phone (580) 286-2600
1127 S George Nigh Expy
McAlester, OK 74501
Phone (800) 349-7026
3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589
5300 N Independence Ave
Ste 280
Oklahoma City, OK 73112
Phone (405) 552-0155
109 Kerr Blvd
Poteau, OK 74953
Phone (918) 649-1100
2204 E Main St
Stigler, OK 74462
Phone (918) 967-9200
205 Dallas St
Talihina, OK 74571
Phone (918) 567-3636
1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440
Interoperability endpoints
- smccormick628512@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 79150 | OK | Yes |
Addresses
Primary practice location
550 E Washington Blvd Ste 100
Crescent City, CA 95531-8161
Mailing address
530 Demoss St.
Lordsburg, NM 88045
Phone (575) 542-2369
Other names
- Shaun Rebecca McCormick
Other providers in Crescent City, CA
- Kelly Dunn
- Lucie Dunn
- Maria Stanton Durazo
- Jennifer Jo Dutton
- Kristi Ann Edgar
- Nabil Elkhoury
- Christy Eileen Emrich
- Enderts Drug Store Inc
- Larry Allen Eninger
- Envoy of Hope Inc
All providers in Crescent City, CA · Primary Care Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.