Provider Demographics
NPI:1598752743
Name:JEFFREY, SHANNON M (MSN, ARNP)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:M
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-1107
Mailing Address - Country:US
Mailing Address - Phone:785-238-4711
Mailing Address - Fax:785-238-4260
Practice Address - Street 1:361 GRANT AVE
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4201
Practice Address - Country:US
Practice Address - Phone:785-238-4711
Practice Address - Fax:785-238-4260
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSMJ1111880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSJEFFREYOtherWPPA
KS161261OtherBLUE CROSS BLUE SHIELD
KS0000161261OtherTRICARE
KS0000161261OtherTRICARE
KS161261Medicare ID - Type Unspecified