Healthcare Provider Details

I. General information

NPI: 1255547287
Provider Name (Legal Business Name): SHANNON K BRASHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 SE COMBS FLAT RD STE 1200
PRINEVILLE OR
97754-2562
US

IV. Provider business mailing address

1103 NE ELM ST
PRINEVILLE OR
97754-1664
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-6263
  • Fax: 541-447-8724
Mailing address:
  • Phone: 541-447-6263
  • Fax: 541-447-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2787
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA152859
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: