Individual provider Active NPI

Amanda Danyielle Kershaw, PA-C

  • Medical Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1912368523
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2614 Issued in OK
Practice address
800 NE 10TH St
Oklahoma City, OK 73104-5418
Phone
(405) 271-8001
NPI assigned
Mar 9, 2016
Last updated
Nov 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA.0007857 CO
Medical Physician Assistant 363AM0700X 2614 OK Primary

Addresses

Primary practice location

800 NE 10TH St
Oklahoma City, OK 73104-5418

Mailing address

800 NE 10TH St FL 6
Oklahoma City, OK 73104-5418
Phone (405) 271-8001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20160616001038 OK Practitioner - Physician Assistant 4082905385 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ou Health Partners IncGroup PAC ID 5991105876, 1,167 clinicians

Practice addresses (Care Compare)

800 NE 10TH St
Ouhp Stephenson Cancer Center
Oklahoma City, OK 73104-5418
Phone (405) 271-1112

900 NE 10TH St
Ouhp Family Medicine
Oklahoma City, OK 73104-5420
Phone (572) 244-0065

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0007857COMDMedical Physician Assistant
2614OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Nov 2, 2021 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince May 7, 2016 Accepting new patients
Summit Medical Center Past Accepting new patients
Ou Medicine Inc. Past Accepting new patients

Locations

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1457481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1912368523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 NE 10TH ST FL 6",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045418",
            "telephone_number": "405-271-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 NE 10TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045418",
            "telephone_number": "405-271-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSHAW",
        "first_name": "AMANDA",
        "middle_name": "DANYIELLE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-09",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0007857",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.