Healthcare Provider Details

I. General information

NPI: 1790186823
Provider Name (Legal Business Name): JENNIFER ANN SHOOK MSN, RN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W TECH RD
MIAMISBURG OH
45342-0955
US

IV. Provider business mailing address

PO BOX 933421
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3600
  • Fax: 937-641-5802
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA 13243-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: