Active NPI
Ian Courtney Shenk
- Nurse Practitioner
- Salt Lake City, UT
National Provider Identifier
1730007857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 12076826-4405
- Practice address
- 8TH Ave C St
Salt Lake City, UT 84143-0001 - Phone
- (801) 898-1819
- NPI assigned
- Jul 7, 2026
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 12076826-4405 | UT | Primary |
Addresses
Primary practice location
8TH Ave C St
Salt Lake City, UT 84143-0001
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Other practice location 1
2928 W LeMay Ave
West Valley City, UT 84119-2860
Phone (602) 570-2011
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.officeally.io.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Bluemark LLC / Office Ally |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1783382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787616000000",
"number": "1730007857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27128",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841270128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8TH AVE C ST",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841430001",
"telephone_number": "801-898-1819"
}
],
"practiceLocations": [
{
"address_1": "2928 W LeMay Ave",
"address_purpose": "LOCATION",
"city": "West Valley City",
"state": "UT",
"postal_code": "841192860",
"country_code": "US",
"telephone_number": "602-570-2011",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHENK",
"first_name": "IAN",
"middle_name": "COURTNEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-07-07",
"last_updated": "2026-08-25",
"certification_date": "2026-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "UT",
"license": "12076826-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.officeally.io.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.2019.3",
"affiliationName": "Bluemark LLC / Office Ally",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "1300 SE Cardinal Ct Ste 190",
"city": "Vancouver",
"state": "WA",
"country_code": "US",
"postal_code": "986839683",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.