Provider Demographics
NPI:1720422934
Name:JONES, SHANNON R (PMHNP-BC, APRN, RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:PMHNP-BC, APRN, RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:K
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC, APRN, RN
Mailing Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1140
Mailing Address - Country:US
Mailing Address - Phone:866-280-0620
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:026-086-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9506341363LP0808X
CA95006341363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health