Shannon Denise Ijams, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

906 Issued in OK

Practice address

1334 N Lansing Ave
Tulsa, OK 74106-5907

Phone

(918) 587-2171

NPI assigned

Jan 5, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shannon Denise Aberle Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1154691244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268838",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268838",
            "telephone_number": "918-619-4600",
            "fax_number": "918-619-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 N LANSING AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741065907",
            "telephone_number": "918-587-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IJAMS",
        "first_name": "SHANNON",
        "middle_name": "DENISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "ABERLE",
            "middle_name": "DENISE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.