MEDICARE: SHAEANNA JONES-SHOESMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1659235489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAEANNA JONES-SHOESMITH

Provider Business Mailing Address
First Line	:	2668 SCOVILLE RD
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3468
Country	:	US
Telephone Number	:	541-415-9981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 NE 7TH ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1451
Country	:	US
Telephone Number	:	541-415-9981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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