Active NPI
Shannon Slack
- Nurse Practitioner
- Olympia, WA
National Provider Identifier
1790161222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AP60571003
- Practice address
- 2000 Lakeridge Dr SW
Olympia, WA 98502-6001 - Phone
- (360) 754-2941
- NPI assigned
- Aug 6, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP60571003 | WA | Primary |
Addresses
Primary practice location
2000 Lakeridge Dr SW
Olympia, WA 98502-6001
Mailing address
9039 Silverspot Dr SE
Tumwater, WA 98501-5575
Phone (360) 791-7133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP60571003 | WA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492560000000",
"number": "1790161222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9039 SILVERSPOT DR SE",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985015575",
"telephone_number": "360-791-7133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 LAKERIDGE DR SW",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985026001",
"telephone_number": "360-754-2941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLACK",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-06",
"last_updated": "2017-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP60571003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.