Active NPI
Kathleen K Shannon, CNM
- Advanced Practice Midwife
- Beltsville, MD
National Provider Identifier
1952546491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- R179174
- Practice address
- 6300 Odell Rd
Beltsville, MD 20705-4107 - Phone
- (703) 801-4093
- Fax
- (833) 694-0324
- NPI assigned
- Dec 12, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | RN1014773 | DC | |
| Advanced Practice Midwife | 367A00000X | R179174 | MD | Primary |
Addresses
Primary practice location
6300 Odell Rd
Beltsville, MD 20705-4107
Mailing address
6300 Odell Rd
Beltsville, MD 20705-4107
Phone (703) 801-4093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN1014773 | DC | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678060800000",
"number": "1952546491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6300 ODELL RD",
"city": "BELTSVILLE",
"state": "MD",
"postal_code": "207054107",
"telephone_number": "703-801-4093",
"fax_number": "833-694-0324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6300 ODELL RD",
"city": "BELTSVILLE",
"state": "MD",
"postal_code": "207054107",
"telephone_number": "703-801-4093",
"fax_number": "833-694-0324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "KATHLEEN",
"middle_name": "K",
"credential": "CNM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-12",
"last_updated": "2023-03-06",
"certification_date": "2023-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "DC",
"license": "RN1014773",
"primary": false
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "MD",
"license": "R179174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beltsville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.