Shannon Whaley, CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

655 Issued in MN

Practice address

895 7TH St E
Saint Paul, MN 55106-3871

Phone

(651) 602-7500

Fax

(651) 222-1305

NPI assigned

Jul 23, 2013

Last updated

Mar 1, 2023By 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 2

Addresses

Other names 1

• Shannon Bruner Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swhaley733244@direct.ochin.org

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.

• West Side Community Health Services, Inc.

  dba McDonough Homes Clinic

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, MN
  • NPI 1821149964
  Medicare reassignment NPD
• West Side Community Health Services, Inc.

  dba MINNESOTA COMMUNITY CARE MBC - St. Paul

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, MN
  • NPI 1043187289
  NPD
• West Side Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Saint Paul, MN
  • NPI 1699809939
  NPD

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1780026419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 7TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551063871",
            "telephone_number": "651-602-7500",
            "fax_number": "651-222-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 7TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551063871",
            "telephone_number": "651-602-7500",
            "fax_number": "651-222-1305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Silver Lake Rd NW",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "New Brighton",
            "state": "MN",
            "postal_code": "551121786",
            "country_code": "US",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHALEY",
        "first_name": "SHANNON",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-23",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "MN",
            "license": "R1740327",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "BRUNER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Justin Jeffrey Wetzel, PHARM. D.
• Deborah Lee Wexler, MD
• Ron Wexler, M.D.
• Yosef Y Wexler, M.D
• Janet Whaley
• Nichole Wheatley, DTR
• Dena Wheeler
• Katherine Michelle Wheeler, LICSW
• Robert Michael Wheeler, MD
• Robyn Lynn Wheeler, RN

• Psychiatric/Mental Health Nurse Practitioner in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.