Shannon Elizabeth Kersey, LPA

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

2531 Issued in NC

Practice address

4425 Randolph Rd
Suite 208
Charlotte, NC 28211-2351

Phone

(704) 323-6586

NPI assigned

Aug 31, 2006

Last updated

Sep 25, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Shannon Kersey, Lpa

  • Clinical Child & Adolescent Psychologist
  • Charlotte, NC
  • NPI 1164708228
  NPD (past) Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1720190234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 RANDOLPH RD",
            "address_2": "SUITE 208",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112351",
            "telephone_number": "704-323-6586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 RANDOLPH RD",
            "address_2": "SUITE 208",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112351",
            "telephone_number": "704-323-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSEY",
        "first_name": "SHANNON",
        "middle_name": "ELIZABETH",
        "credential": "LPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "2531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107171",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Joseph Kerrigan, MD
• Kristi Ann Kerrigan, R.R.A., R.T.
• Kerry Taylor Inc (It Takes A Village)
• Carrie A Kerscher, SLP
• Samantha Kersey
• John William Kershner, PA-C
• Mary Elizabeth Kerstein, SLP
• Brian Paul Kersten, MD
• Lewis Joseph Kerwin, MD
• Alex Michael Kesler, M.D.

• Clinical Child & Adolescent Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Child & Adolescent Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.