MEDICARE: AUSTIN JORDAN SHINABERRY PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	6705	TN

General Provider Information

NPI Number	:	1053175661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN JORDAN SHINABERRY PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	6490 MEMPHIS ARLINGTON RD STE 106
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-7439
Country	:	US
Telephone Number	:	901-762-1531
Fax Number	:

Provider Business Practice Location Address
First Line	:	6490 MEMPHIS ARLINGTON RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-7417
Country	:	US
Telephone Number	:	901-762-1531
Fax Number	:	901-762-1532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	09/19/2025

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