Healthcare Provider Details

I. General information

NPI: 1639689896
Provider Name (Legal Business Name): JOHN NELSON SHIRLEY FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11417 124TH AVE NE STE 100
KIRKLAND WA
98033-4677
US

IV. Provider business mailing address

220 W GRANDVIEW AVE APT A31
SUNNYSIDE WA
98944-1876
US

V. Phone/Fax

Practice location:
  • Phone: 800-640-3451
  • Fax: 385-287-1900
Mailing address:
  • Phone: 770-316-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017016476
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70106932
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: