Individual provider Active NPI

Jennifer Ann Shook, MSN, RN CPNP-PC

  • Pediatric Nurse Practitioner
  • Miamisburg, OH
National Provider Identifier
1790186823
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APRN.CNP.13243 Issued in OH
Practice address
3333 W Tech Rd
Miamisburg, OH 45342-0955
Phone
(937) 641-3600
Fax
(937) 641-5802
NPI assigned
Sep 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X APRN.CNP.13243 OH Primary

Addresses

Primary practice location

3333 W Tech Rd
Miamisburg, OH 45342-0955

Mailing address

PO Box 933421
Cleveland, OH 44193-0039
Phone (937) 641-5072

Other practice location 1

7787 Cox Ln
West Chester, OH 45069-6549
Phone (513) 644-8081

Other practice location 2

1425 N Fairfield Rd Ste 130
Beavercreek, OH 45432-2674
Phone (937) 320-1950

Other practice location 3

3301 Dayton Xenia Rd Ste 200
Beavercreek, OH 45432-2759
Phone (937) 641-5098

Other practice location 4

662 N Main St
Springboro, OH 45066-9553
Phone (937) 641-5066

Other practice location 5

3333 W Tech Rd
Miamisburg, OH 45342-0955
Phone (937) 641-5725

Other practice location 6

5501 Far Hills Ave Ste 200
Dayton, OH 45429-2203
Phone (937) 436-2866

Other practice location 7

1711 Germantown Pike
Dayton, OH 45417
Phone (937) 641-3142

Other practice location 8

792 Northwoods Blvd
Vandalia, OH 45377-9462
Phone (937) 641-4236

Other practice location 9

4475 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 641-3141

Other practice location 10

1 Childrens Plz
Dayton, OH 45404-1873
Phone (937) 641-4000

Other practice location 11

6044 Wilmington Pike
Dayton, OH 45459-7006
Phone (937) 641-3270

Other practice location 12

8501 Old Troy Pike
Huber Heights, OH 45424-1054
Phone (937) 641-4360

Other identifiers 1

IdentifierTypeStateIssuer
0114972MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160908001324 OH Practitioner - Nurse Practitioner 5496041022 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
APRN.CNP.13243OHMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Children'S Hospital Pediatrics CurrentSince Jul 1, 2024 Accepting new patients
Dayton Children'S Hospital Pediatrics CurrentSince Jul 1, 2024 Accepting new patients

Locations

3301 Dayton Xenia Rd
Ste 200
Beavercreek, OH 45432
Phone (937) 641-5098

1425 N Fairfield Rd
Ste 130
Beavercreek, OH 45432
Phone (937) 320-1950

5501 Far Hills Ave
Ste 200
Dayton, OH 45429
Phone (937) 436-2866

1711 Germantown St
Dayton, OH 45417
Phone (937) 641-3142

1 Childrens Plz
Dayton, OH 45404
Phone (937) 641-3600

8501 Old Troy Pike
Huber Heights, OH 45424
Phone (937) 233-1095

5450 Far Hills Ave
Ste 110
Kettering, OH 45429
Phone (937) 299-9060

4475 Far Hills Ave
Kettering, OH 45429
Phone (937) 641-3141

967 Bellefontaine Ave
Lima, OH 45804
Phone (419) 224-1330

8809 Wilkens Blvd
Mason, OH 45040
Phone (513) 701-6907

3333 W Tech Rd
Miamisburg, OH 45342
Phone (937) 641-3400

662 N Main St
Springboro, OH 45066
Phone (937) 641-5066

7787 Cox Ln
West Chester, OH 45069
Phone (513) 644-8081

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779926400000",
    "number": "1790186823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933421",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-5072",
            "fax_number": "937-641-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 W TECH RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453420955",
            "telephone_number": "937-641-3600",
            "fax_number": "937-641-5802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7787 Cox Ln",
            "address_purpose": "LOCATION",
            "city": "West Chester",
            "state": "OH",
            "postal_code": "450696549",
            "country_code": "US",
            "telephone_number": "513-644-8081",
            "fax_number": "513-847-1192",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1425 N Fairfield Rd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454322674",
            "country_code": "US",
            "telephone_number": "937-320-1950",
            "fax_number": "937-320-9332",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3301 Dayton Xenia Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454322759",
            "country_code": "US",
            "telephone_number": "937-641-5098",
            "fax_number": "937-912-9395",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "662 N Main St",
            "address_purpose": "LOCATION",
            "city": "Springboro",
            "state": "OH",
            "postal_code": "450669553",
            "country_code": "US",
            "telephone_number": "937-641-5066",
            "fax_number": "937-550-9797",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W Tech Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420955",
            "country_code": "US",
            "telephone_number": "937-641-5725",
            "fax_number": "937-350-3050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5501 Far Hills Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454292203",
            "country_code": "US",
            "telephone_number": "937-436-2866",
            "fax_number": "937-436-1468",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 Germantown Pike",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "45417",
            "country_code": "US",
            "telephone_number": "937-641-3142",
            "fax_number": "937-641-4172",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "792 Northwoods Blvd",
            "address_purpose": "LOCATION",
            "city": "Vandalia",
            "state": "OH",
            "postal_code": "453779462",
            "country_code": "US",
            "telephone_number": "937-641-4236",
            "fax_number": "937-641-4237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4475 Far Hills Ave",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454292405",
            "country_code": "US",
            "telephone_number": "937-641-3141",
            "fax_number": "937-641-3190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Childrens Plz",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454041873",
            "country_code": "US",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6044 Wilmington Pike",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454597006",
            "country_code": "US",
            "telephone_number": "937-641-3270",
            "fax_number": "937-641-6108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8501 Old Troy Pike",
            "address_purpose": "LOCATION",
            "city": "Huber Heights",
            "state": "OH",
            "postal_code": "454241054",
            "country_code": "US",
            "telephone_number": "937-641-4360",
            "fax_number": "937-641-3791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOOK",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MSN, RN CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-08",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.13243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0114972",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miamisburg, OH

Sources for this page

Verify at the official NPI Registry.