Healthcare Provider Details

I. General information

NPI: 1467306381
Provider Name (Legal Business Name): ISIAH SHAUGHNESSY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 E MADISON AVE
IOLA KS
66749-3555
US

IV. Provider business mailing address

523 BRIARWOOD DR
IOLA KS
66749-2700
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-6933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number85782
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-85782-032
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number13-154912-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: