Healthcare Provider Details

I. General information

NPI: 1659235489
Provider Name (Legal Business Name): SHAEANNA JONES-SHOESMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NE 7TH ST
GRANTS PASS OR
97526-1451
US

IV. Provider business mailing address

2668 SCOVILLE RD
GRANTS PASS OR
97526-3468
US

V. Phone/Fax

Practice location:
  • Phone: 541-415-9981
  • Fax:
Mailing address:
  • Phone: 541-415-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: