Shanna Kidd, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA06691 Issued in TX

Practice address

701 W 5TH St
Odessa, TX 79763-4206

Phone

(432) 335-1500

Fax

(432) 335-1537

NPI assigned

Apr 1, 2010

Last updated

Nov 12, 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 names 1

• Shanna Jo Wheatley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Goodside Health Medical, PLLC

  • Pediatrics Physician
  • Albuquerque, NM
  • NPI 1033972716

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289520000000",
    "number": "1851616916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W 5TH ST",
            "address_2": "SUITE 1C34",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797634206",
            "telephone_number": "432-335-5126",
            "fax_number": "432-335-1807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W 5TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797634206",
            "telephone_number": "432-335-1500",
            "fax_number": "432-335-1537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDD",
        "first_name": "SHANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-01",
        "last_updated": "2010-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNA",
            "last_name": "WHEATLEY",
            "middle_name": "JO",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tanzina Khan
• Pankaj Khandelwal, MD
• Krish Ashok Kherajani
• Hildano Kidangathazha
• Ashley Nichole Kidd, OTR
• Kids Dentistree of Abbeville-Odessa PLLC
• Nam H Kim
• Sam Eun Kim, M.D.
• Younggil Kim, DDS
• Andrew Scott Kimber, DO

• Physician Assistant in Odessa, TX
• Providers in Odessa, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.