MEDICARE: JADEN TANISE SHIELDS

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	124Q00000X	Dental Hygienist		TX

General Provider Information

NPI Number	:	1609738731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADEN TANISE SHIELDS

Provider Business Mailing Address
First Line	:	9440 LEGENDS WAY
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:	254-288-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	9440 LEGENDS WAY, FORT HOOD
Second Line	:
City	:	APO
State	:	AA
Zip	:	76544
Country	:	US
Telephone Number	:	254-288-7863
Fax Number	:

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

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	12/09/2025

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Directions to “ JADEN TANISE SHIELDS ” Practice Location

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