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General NPI Number Information
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NPI Number | 1053175661
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Entity Type | Individual
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Provider Name | AUSTIN JORDAN SHINABERRY PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 6490 MEMPHIS ARLINGTON RD
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City | BARTLETT
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State | TN
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Zip | 38135-7417
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Country | US
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Telephone | 901-762-1531
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Fax | 901-762-1532
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Provider Business Mailing Address
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Address Line | 6490 MEMPHIS ARLINGTON RD STE 106
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City | BARTLETT
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State | TN
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Zip | 38135-7439
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Country | US
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Telephone | 901-762-1531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 6705
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License Number State | TN
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