Healthcare Provider Details

I. General information

NPI: 1356894422
Provider Name (Legal Business Name): SHANNON LYNNE PORTER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 W MEEKER BLVD # 200
SUN CITY WEST AZ
85375-5284
US

IV. Provider business mailing address

14416 W MEEKER BLVD # 200
SUN CITY WEST AZ
85375-5284
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3800
  • Fax: 623-285-2713
Mailing address:
  • Phone: 623-867-3800
  • Fax: 623-285-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60672144
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60672144
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number279033
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: