Healthcare Provider Details

I. General information

NPI: 1164123725
Provider Name (Legal Business Name): SHANNON DAWN KLEINSCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9321 W THOMAS RD STE 405
PHOENIX AZ
85037-3399
US

IV. Provider business mailing address

401 COMMERCE ST STE 600
NASHVILLE TN
37219-2518
US

V. Phone/Fax

Practice location:
  • Phone: 623-236-8507
  • Fax:
Mailing address:
  • Phone: 615-345-6903
  • Fax: 615-345-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number285525
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: