Active NPI
Jonathan Shank
- School Psychologist
- Spencer, WV
National Provider Identifier
1669922092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- A1W134600190
- Practice address
- 813 Capitol St
Spencer, WV 25276-1924 - Phone
- (304) 485-6513
- NPI assigned
- Oct 10, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | A1W134600190 | WV | Primary |
Addresses
Primary practice location
813 Capitol St
Spencer, WV 25276-1924
Mailing address
2507 9TH Ave
Parkersburg, WV 26101-5855
Phone (304) 485-6513
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 |
|---|---|---|---|
| A1W134600190 | WV | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476057600000",
"number": "1669922092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2507 9TH AVE",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261015855",
"telephone_number": "304-485-6513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 CAPITOL ST",
"city": "SPENCER",
"state": "WV",
"postal_code": "252761924",
"telephone_number": "304-485-6513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANK",
"first_name": "JONATHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-10",
"last_updated": "2016-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "WV",
"license": "A1W134600190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spencer, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.