Shannon Whitlock, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10942 Issued in AZ

Practice address

830 Ainsworth Dr
Prescott, AZ 86301-1630

Phone

(928) 777-5800

Fax

(928) 776-0405

NPI assigned

Nov 21, 2006

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA, AZ2 enrollments

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 2

Specialty

Physician Assistant

Education

George Washington University School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.whitlock@forefrontdermatology.emadirect.md

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.

• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Gilbert, AZ
  • NPI 1396340162
  Medicare reassignment Care Compare group
• Semler Dermatology, Inc

  • Dermatology Physician
  • Lansdowne, VA
  • NPI 1093868820
  Medicare reassignment
• Arizona Associates in Dermatology and Cosmetic Surgery, LLC

  • Dermatology Physician
  • Prescott, AZ
  • NPI 1659467397
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Prescott, AZ
  • NPI 1417782665
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385
  NPD
• Forefront Dermatology SC

  • Dermatology Physician
  • Cottonwood, AZ
  • NPI 1568227965
  NPD (past)
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1932274578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 AINSWORTH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011630",
            "telephone_number": "928-777-5800",
            "fax_number": "928-776-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITLOCK",
        "first_name": "SHANNON",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "10942",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002157",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173121",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Shannon.Whitlock@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "830 Ainsworth Dr",
            "city": "Prescott",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "863011630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karen Michele White
• Kendria White, LCSW, LIMHP
• Michelle Ann White
• Rachel L. White, DPT
• Simone Maria Whitehead, M.A.
• Whitney James, MD, PC
• Ronald F Whitney, M.D.
• Wholemind Healing Pathways
• Barbara Kathryn Wich, M.D.
• Karl Theodore Wickstrom, M.D.

• Medical Physician Assistant in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.