Healthcare Provider Details

I. General information

NPI: 1891264974
Provider Name (Legal Business Name): SHAWN JONES FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2018
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W UNIVERSITY AVE STE 112
FLAGSTAFF AZ
86001-3154
US

IV. Provider business mailing address

1600 W UNIVERSITY AVE STE 112
FLAGSTAFF AZ
86001-3154
US

V. Phone/Fax

Practice location:
  • Phone: 928-220-6363
  • Fax:
Mailing address:
  • Phone: 928-220-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number220069
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201810869NP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220069
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN180153
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: