Individual provider Active NPI

Shannon Briana Kearns, FNP-C

  • Family Nurse Practitioner
  • Yucaipa, CA
National Provider Identifier
1699572776
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95032187 Issued in CA
Practice address
35281 San Pablo Dr
Yucaipa, CA 92399-5433
Phone
(760) 221-4443
NPI assigned
Feb 26, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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 95032187 CA Primary

Addresses

Primary practice location

35281 San Pablo Dr
Yucaipa, CA 92399-5433

Mailing address

35281 San Pablo Dr
Yucaipa, CA 92399-5433
Phone (760) 221-4443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20250519003192 CA Practitioner - Nurse Practitioner 8527586973 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

12550 Hesperia Rd
Suite 100
Victorville, CA 92395-5873
Phone (760) 241-6666

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95032187CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Mar 10, 2025 Accepting new patients
Providence Medical Foundation CurrentSince Mar 10, 2025 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

18310 US Highway 18
Ste 100
Apple Valley, CA 92307
Phone (760) 240-5505

19333 Bear Valley Rd
Ste 106
Apple Valley, CA 92308
Phone (760) 240-5505

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

12550 Hesperia Rd
Ste 100
Victorville, CA 92395

Organizations & group practices 4

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": "1740528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1699572776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35281 SAN PABLO DR",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995433",
            "telephone_number": "760-221-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35281 SAN PABLO DR",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995433",
            "telephone_number": "760-221-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEARNS",
        "first_name": "SHANNON",
        "middle_name": "BRIANA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-26",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95032187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yucaipa, CA

Sources for this page

Verify at the official NPI Registry.