Provider Demographics
NPI:1770127110
Name:JAMES, SHAWN PATRICK (MS, RD, LD)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PATRICK
Last Name:JAMES
Suffix:
Gender:M
Credentials:MS, RD, LD
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 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:888-777-9170
Mailing Address - Fax:
Practice Address - Street 1:3011 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2546
Practice Address - Country:US
Practice Address - Phone:888-777-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2430133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered