Active NPI
Shannon Smalley
- Specialist
- Spanish Fork, UT
National Provider Identifier
1609300383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 204009858
- Practice address
- 114 E 800 N
Spanish Fork, UT 84660-1209 - Phone
- (801) 794-1490
- NPI assigned
- Apr 19, 2017
- Last updated
- Apr 19, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 204009858 | UT | Primary |
Addresses
Primary practice location
114 E 800 N
Spanish Fork, UT 84660-1209
Mailing address
114 E 800 N
Spanish Fork, UT 84660-1209
Phone (801) 794-1490
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821299751 | Other | UT | NPI |
| 1194744615 | Other | UT | NPI |
| 1063481646 | Other | UT | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 204009858 | UT | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492560000000",
"number": "1609300383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 E 800 N",
"city": "SPANISH FORK",
"state": "UT",
"postal_code": "846601209",
"telephone_number": "801-794-1490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 E 800 N",
"city": "SPANISH FORK",
"state": "UT",
"postal_code": "846601209",
"telephone_number": "801-794-1490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALLEY",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-19",
"last_updated": "2017-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "UT",
"license": "204009858",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1821299751",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1194744615",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1063481646",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spanish Fork, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.