SHANNON HENDERSON (NPI# 1740532480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740532480 |
| Entity Type | Individual |
| Full Name | SHANNON HENDERSON |
| Credential | NP |
| Practice Address |
520 Medical Center Dr Ste 201 Medford OR 97504-4334 |
| Mailing Address |
Po Box 748157 Los Angeles CA 90074-8157 |
| Practice Telephone | 5417895711 |
| Practice Fax Number | 5417895710 |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2020-06-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 202004735NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 5009257 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1001 Blythe Blvd, Ste 300 - Cardiac Surgery, Charlotte, NC 282035866 | 7043730212 | |
| 10650 Park Rd, Ste 220, Charlotte, NC 282108538 | 7046673840 | |
| 200 Medical Park Dr, Ste 230, Concord, NC 280252982 | 7044031349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447803523 | Shannon Henderson | Physical Therapist | 13336 Industrial Rd Ste 105, Omaha, NE 68137-1124 | 2019-07-18 |
| 1083114813 | Shannon Henderson | Behavior Technician | 1353 E Main St, Brownsburg, IN 46112-1433 | 2018-02-19 |
| 1194006387 | Shannon Henderson | Counselor | 1140 N Hudson Ave, Oklahoma City, OK 73103-3918 | 2011-09-01 |
| Street Address |
520 MEDICAL CENTER DR STE 201 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-4334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780162032 | Toni Anne Baca | Nurse Practitioner | 520 Medical Center Dr Ste 201, Medford, OR 97504-4334 | 2018-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689280620 | Danna Rae Morgan | Nurse Practitioner | 539 N Barneburg Rd, Medford, OR 97504-6678 | 2020-09-16 |
| 1609406164 | Andey Amata-kynvi | Nurse Practitioner | 99 Jerome St, Medford, MA 02155-6736 | 2020-01-23 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1215406459 | Natalia Eltabaa | Nurse Practitioner | 143b Atsion Rd, Medford, NJ 08055 | 2018-11-16 |
| 1922542489 | Genevieve Lumsden | Nurse Practitioner | 30 Auburn St, Medford, MA 02155-3623 | 2016-12-16 |
| 1821456708 | Sonia Nerteley Nettey | Nurse Practitioner | 86 Otis St Unit 2, Medford, MA 02155-4031 | 2016-02-05 |
| 1548577307 | Elaina S Jensen | Nurse Practitioner | 2385 Table Rock Rd # 103, Medford, OR 97501-1510 | 2010-08-31 |
| 1891928495 | Roberta Marie Bell | Nurse Practitioner | 617 Palm St, Medford, OR 97501 | 2009-08-29 |
| 1750567129 | Robert Anthony Kiesecker Jr. | Nurse Practitioner | 781 Black Oak Dr Ste 102, Medford, OR 97504-9501 | 2008-01-16 |
| 1518055912 | Debbie Buck | Nurse Practitioner | 128 Route 70 Ste 1, Medford, NJ 08055-2371 | 2006-10-11 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.