Provider Demographics
NPI:1750011607
Name:SHOEMAKE, JADYN BRYNN
Entity Type:Individual
Prefix:MS
First Name:JADYN
Middle Name:BRYNN
Last Name:SHOEMAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N SHIPP ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5725
Mailing Address - Country:US
Mailing Address - Phone:575-964-2944
Mailing Address - Fax:
Practice Address - Street 1:518 N SHIPP ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5725
Practice Address - Country:US
Practice Address - Phone:575-964-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-12023104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker