Kerry Ann Shaughnessy, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

60599869 Issued in WA

Practice address

6424 N 9TH St
Tacoma, WA 98406-2091

Phone

(253) 565-4484

Fax

(253) 565-5823

NPI assigned

Nov 26, 2019

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 1

Medicare fee-for-service enrollment

Enrolled in WA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Puyallup Tribal Health Authority

  • Primary Care Clinic/Center
  • Tacoma, WA
  • NPI 1063455665
  Medicare reassignment NPD
• Puyallup Tribal Health Authority

  • Adult Mental Health Clinic/Center
  • Tacoma, WA
  • NPI 1255378782
  NPD
• Hopesparks

  • Mental Health Counselor
  • Tacoma, WA
  • NPI 1871660811

  Clinical

  NPD (past)
• Olive Crest

  • Community/Behavioral Health Agency
  • Tacoma, WA
  • NPI 1508491697
  NPD (past)

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

{
    "created_epoch": "1574726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1740826593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 N 9TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984062091",
            "telephone_number": "253-565-4484",
            "fax_number": "253-565-5823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 N 9TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984062091",
            "telephone_number": "253-565-4484",
            "fax_number": "253-565-5823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAUGHNESSY",
        "first_name": "KERRY",
        "middle_name": "ANN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-26",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "60599869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL WORKER INDEPENDENT CLINICAL LICENSE",
            "identifier": "60599869",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheree Sharpe, M.D.
• Venus Balag Sharpe
• Julie Christine Johnson Sharrette, DR.
• Teralyn Shasteen
• Irina S Shatalova
• Muhammad I Shaukat, M.D.
• David Lee Shaulis
• Heather Shaver
• Caroline Marie Shaw, CDP
• Donald Lee Shaw, RPH

• Clinical Social Worker in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; 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.