MEDICARE: SHAWN JONES FNP

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	163WG0000X	General Practice Registered Nurse	RN180153	AZ
2	363L00000X	Nurse Practitioner	220069	AZ
3	363LF0000X	Family Nurse Practitioner	220069	AZ
4	363L00000X	Nurse Practitioner	201810869NP-PP	OR

General Provider Information

NPI Number	:	1891264974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN JONES FNP

Provider Business Mailing Address
First Line	:	1600 W UNIVERSITY AVE STE 112
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3154
Country	:	US
Telephone Number	:	928-220-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W UNIVERSITY AVE STE 112
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3154
Country	:	US
Telephone Number	:	928-220-6363
Fax Number	:

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

Provider Enumeration Date	:	11/18/2018
Last Update Date	:	02/05/2026

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