Provider Demographics
NPI:1619864626
Name:RURAL MEDICINE DIRECT
Entity type:Organization
Organization Name:RURAL MEDICINE DIRECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SHEALY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-725-5789
Mailing Address - Street 1:5516 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9104
Mailing Address - Country:US
Mailing Address - Phone:801-725-5789
Mailing Address - Fax:
Practice Address - Street 1:2020 MILLIGAN WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5894
Practice Address - Country:US
Practice Address - Phone:801-725-5789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9503558OtherNURSE PRACTITIONER
OR10045481OtherNURSE PRACTITIONER