Healthcare Provider Details

I. General information

NPI: 1912818469
Provider Name (Legal Business Name): JOHNNY SHAWN HAMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 S CHUGACH ST
PALMER AK
99645-6756
US

IV. Provider business mailing address

1633 S CHUGACH ST
PALMER AK
99645-6756
US

V. Phone/Fax

Practice location:
  • Phone: 907-795-9401
  • Fax:
Mailing address:
  • Phone: 907-795-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: