Shannon P Dark, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2008009364 Issued in MO

Practice address

3550 S National Ave
Suite 200
Springfield, MO 65807-7309

Phone

(417) 269-9300

NPI assigned

Apr 20, 2009

Last updated

Nov 19, 2010By 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

Other names 1

• Shannon P Pippin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1720221849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 S NATIONAL AVE",
            "address_2": "SUITE 200",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077309",
            "telephone_number": "417-269-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 S NATIONAL AVE",
            "address_2": "SUITE 200",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077309",
            "telephone_number": "417-269-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DARK",
        "first_name": "SHANNON",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-20",
        "last_updated": "2010-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2008009364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00859517",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "PIPPIN",
            "middle_name": "P",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aaron Richard Dannegger, DDS
• Kesia Danner-Bowman, PT
• Katie Lynn Dansby, MS, PLPC
• Elizabeth M Dardenne, MA, LPC
• John Luke Darity, FNP
• Michelle Audrey Darmadi, MD
• David Darmsteadter, M.D.
• Amanda Dawn Darris, LMT
• Jamil Darrouj, MD
• Darrow Enterprises LLC

• Clinical Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; 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.

Verify at the official NPI Registry.