Shirley Becton McKenzie, PPCNP-BC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

0024171110 Issued in VA

Practice address

401 Carpenter Rd BLDG 525
1015
Fort Myer, VA 22211-1009

Phone

(703) 696-3614

Fax

(703) 696-9248

NPI assigned

Oct 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1740365493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CARPENTER RD BLDG 525",
            "address_2": "1015",
            "city": "FORT MYER",
            "state": "VA",
            "postal_code": "222111009",
            "telephone_number": "833-853-1392",
            "fax_number": "703-696-9248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CARPENTER RD BLDG 525",
            "address_2": "1015",
            "city": "FORT MYER",
            "state": "VA",
            "postal_code": "222111009",
            "telephone_number": "703-696-3614",
            "fax_number": "703-696-9248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "SHIRLEY",
        "middle_name": "BECTON",
        "credential": "PPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "VA",
            "license": "0017141236",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "VA",
            "license": "0024171110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02807327",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02807327",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel Margolis
• Annmarie McBride
• Sara Greene McCauley, LCSW
• Alexander McCready
• Ann Stewart McKenney, MD
• Kelly Mitzen, PA-C
• Kisuk K Moore, RN
• Liliana Alexandra Moreno Santander
• Daniel Patrick Morgan, DO
• Kathryn Nicole Morrill, LICSW

• Pediatric Nurse Practitioner in Fort Myer, VA
• Providers in Fort Myer, VA by specialty
• Pediatric Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; 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.