Healthcare Provider Details

I. General information

NPI: 1861204174
Provider Name (Legal Business Name): SHAWN MICHAEL SKOK FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N PINES RD
SPOKANE VALLEY WA
99206-4939
US

IV. Provider business mailing address

PO BOX 421
SPOKANE WA
99210-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-893-8140
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax: 509-227-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61637968
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: