MR. SHANNON LEE SMITH (NPI# 1154686814) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154686814 |
| Entity Type | Individual |
| Full Name | MR. SHANNON LEE SMITH |
| Credential | PMHNP, MPH |
| Practice Address |
619 Nw 6th Ave Fl 3 Portland OR 97209-3964 |
| Mailing Address |
619 Nw 6th Ave Fl 5 Portland OR 97209-3964 |
| Practice Telephone | 5039885020 |
| Practice Fax Number | 5039885022 |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2019-11-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
201250082NP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 22959 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518568203 | Shannon Smith | Counselor | 99 Huckleberry Ct, Three Bridges, NJ 08887-2109 | 2020-11-08 |
| 1821603267 | Shannon Alexandria Smith | Dietitian, Registered | 20621 Ne 1st Ct, Miami, FL 33179-1702 | 2020-09-12 |
| 1790316040 | Shannon Machelle Smith | Nurse Practitioner | 7705 Happy Hollow Dr, Mint Hill, NC 28227-8518 | 2020-01-27 |
| 1750925392 | Shannon Joy Smith | Nurse Practitioner | 152 Pearson Rd, Greer, SC 29651-7146 | 2019-11-06 |
| 1104308014 | Shannon Lynn Smith | Massage Therapist | 15131 Northville Rd, Plymouth, MI 48170-2548 | 2018-09-06 |
| 1548747181 | Shannon Marie Smith | Psychologist | 146 2nd St N Ste 305, Saint Petersburg, FL 33701-3361 | 2018-07-26 |
| 1942726393 | Shannon Elizabeth Smith | Counselor | 3535 S Sherwood Forest Blvd Ste 227, Baton Rouge, LA 70816-2255 | 2017-08-17 |
| 1043749450 | Shannon Michelle Smith | Marriage & Family Therapist | 707 W 5th Ave Apt 1116, Spokane, WA 99204-2780 | 2017-06-08 |
| 1033640644 | Shannon Elizabeth Smith | Social Worker | 212 W Red Bridge Rd, Kansas City, MO 64114-5136 | 2017-03-24 |
| 1518311240 | Shannon Kathleen Smith | Licensed Practical Nurse | 9040 Jackson Avenue, Attn Mchk-clq-c, Madigan Army Medical Center, Tacoma, WA 98431-1000 | 2016-04-19 |
| Street Address |
619 NW 6TH AVE FL 3 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97209-3964 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962496885 | Paul William Denouden | Internal Medicine | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2005-09-07 |
| 1376161331 | Jamie Nicole Christianson | Community Health Worker | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2020-07-07 |
| 1952928301 | Bridget Neilson | Social Worker | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2020-07-01 |
| 1770100406 | Kristin Rae Cedar | Social Worker | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2020-06-29 |
| 1417574153 | Samuel Francis Junge | Community Health Worker | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2020-06-29 |
| 1366836900 | Virginia Clare Weeks | Internal Medicine | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2015-03-21 |
| 1396877056 | Margaret Joan Retondo | Internal Medicine | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2007-03-09 |
| 1396873444 | Michael Stephen Macveigh | Internal Medicine | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2007-03-01 |
| 1215080387 | Maria Katherine Kosmetatos | Nurse Practitioner | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2007-01-19 |
| 1265513675 | James E Mcdonald | Nurse Practitioner | 619 Nw 6th Ave Fl 3, Portland, OR 97209-3964 | 2006-10-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508476250 | Harrington Health Clinic | Nurse Practitioner | 310 Nw Glisan Street, Portland, OR 97209 | 2020-08-07 |
| 1619599636 | Rivers Way Training Clinic | Community/Behavioral Health | 2049 Nw Hoyt, Portland, OR 97209 | 2020-05-13 |
| 1518590538 | Julie Kay Igarta | Registered Nurse | 140 Northwest 14th Avenue, Portland, OR 97209 | 2020-02-18 |
| 1407492002 | Oregon Injection Clinic | Clinic/Center | 1500 Nw Lovejoy, 106, Portland, OR 97209 | 2019-11-19 |
| 1487202883 | Ann Tesora | Massage Therapist | 1320 Northwest 20th Avenue, Portland, OR 97209 | 2019-08-28 |
| 1972160455 | Vincent Martin | Massage Therapist | 210 Sw 17th Avenue, Portland, OR 97209 | 2019-05-21 |
| 1154896546 | Jennifer Marie Dodd | Social Worker | 1722 Nw Raleigh St Spc 412, Portland, OR 97209 | 2018-10-11 |
| 1922551910 | Ashley Crowell | Physician Assistant | 949 Nw Overton St Unit 306, Portland, OR 97209 | 2016-07-26 |
| 1326408394 | Jennifer Blain | Counselor | 324 Nw Davis, Portland, OR 97209 | 2016-03-03 |
| 1275993255 | Lauren Dodson | Licensed Practical Nurse | 324 Nw Davis St, Portland, OR 97209 | 2016-03-03 |
| Find all providers in zip 97209 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154920148 | Hardcore Happy LLC | Nurse Practitioner | 740 Ne 116th Ct, Portland, OR 97220-2223 | 2020-10-20 |
| 1457967325 | Megan L Langworthy | Nurse Practitioner | 1914 Se 46th Ave, Portland, OR 97215-3148 | 2020-09-16 |
| 1104446681 | Skycloud Psychiatry LLC | Nurse Practitioner | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 |
| 1730712290 | Lucy Anne Bloedon | Nurse Practitioner | 4020 Sw Iowa St, Portland, OR 97221-3423 | 2020-02-12 |
| 1346802733 | Compass Psychiatric Wellness LLC | Nurse Practitioner | 4300 Ne Fremont St Ste 260, Portland, OR 97213-1100 | 2019-07-05 |
| 1548721871 | Cooke Therapy Pllc | Nurse Practitioner | 1125 Se Madison St Ste 102, Portland, OR 97214-3600 | 2019-03-28 |
| 1245719541 | Scott J Whited | Nurse Practitioner | 216 Vaughan St., Mcgeachy Hall, Portland, ME 04101 | 2018-08-08 |
| 1467969220 | Nw Mind-body Wellness, LLC | Nurse Practitioner | 16986 Nw Lynch Ln, Portland, OR 97229-1221 | 2018-01-02 |
| 1811441348 | Anthony Hoy | Nurse Practitioner | 5562 Se Pine St, Portland, OR 97215-1276 | 2016-08-12 |
| 1700241254 | Jacqueline J Cole | Nurse Practitioner | 5228 Ne Hoyt St Ste 300, Portland, OR 97213-3055 | 2015-12-29 |
| Find all providers in PORTLAND | ||||
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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.