Healthcare Provider Details

I. General information

NPI: 1285426361
Provider Name (Legal Business Name): JENNIFER ANNE SHEALY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ANNE DUNFORD NP

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20530 BIG SPRINGS RD STE 3
WEED CA
96094-9600
US

IV. Provider business mailing address

20530 BIG SPRINGS RD STE 3
WEED CA
96094-9600
US

V. Phone/Fax

Practice location:
  • Phone: 541-646-4088
  • Fax: 541-290-1290
Mailing address:
  • Phone: 541-646-4088
  • Fax: 541-290-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number95035588
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number10045481
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95035588
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number95334819
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10045481
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number201508365RN
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number95334819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: