Shannon Taylor Thurston, PA-C
Individual provider Active NPI Medical Physician Assistant · Green River, UT
NPI 1821243684 · NPPES record last updated Feb 5, 2024
Key facts
- NPI
- 1821243684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 7154120-1206 (UT)
- Practice address
- 585 West Main Street
Green River, UT 84525 - Phone
- (435) 564-3434
- Fax
- (435) 564-3214
- NPI assigned
- Nov 20, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150218001176 | UT | Practitioner - Physician Assistant | 5294050100 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wayne Community Health Centers Inc | Current |
Accepting new patients | |
| Taylor G Wright PC | Past |
Accepting new patients | |
| Taylor G Wright PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 7154120-1206 | UT | Yes |
Addresses
Primary practice location
585 West Main Street
Green River, UT 84525
Mailing address
6405 S 3000 E Ste 300
Salt Lake City, UT 84121-6977
Phone (801) 266-3113
Other practice location 1
3152 N University Ave Ste 240
Provo, UT 84604-4746
Phone (801) 900-5655
Other practice location 2
3152 N University Ave Ste 240
Provo, UT 84604
Phone (801) 900-5655
Other providers in Green River, UT
- Green River Medical Center, Inc.
- Brouquelyn Mia Hatfield-Knight
- Kim Thyrill McFarlane
- Tyler J Rundell
- Zackery N Taylor
- Dallin Trout
- Loye West
- Reagan M Whiteleather
All providers in Green River, UT · Medical Physician Assistant in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.