Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1700940855 Individual Practitioner Female Practitioner

Shannon Jackie Clark

Contractor • Vail, AZ

Professional Overview & Biography Verified Profile Summary

Shannon Clark is a registered healthcare professional specializing in Contractor in Vail, AZ. Practice services are available at 12729 S OX CART TRL under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

12729 S Ox Cart Trl

Vail, AZ 856419232

Telephone 5122142841
Fax 5207500056

Specialty Benchmarks & Practice Insights

Comparative analytics for Contractor in Vail, AZ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
7 Specialists

Practicing in Vail, AZ (348 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-12-26
Contractor Primary Specialty

NUCC Taxonomy Code: 171W00000X

State License AZ 11816

A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering).

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
162753 (AZ)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

13 Associated Practitioners
Carmen Lopez

Contractor

NPI 1043374002
Maria Millan

Contractor

NPI 1235466145
Jennifer Lowe

Contractor

NPI 1295899276
NPI 1295979995

Bachelor of Arts

NPI 1306043070
Juan Serna

Contractor

NPI 1609240118

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location December 26, 2024

Registered at 12729 S OX CART TRL, VAIL, AZ 856419232 (Tel: 5122142841)

📍
Updated Business Mailing Address December 26, 2024

Registered at 12729 S OX CART TRL, VAIL, AZ 856419232 (Tel: 5122142841)

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 10750 S KNOLL CREST LN, TUCSON, AZ 857069052 (Tel: 5205742911)

📍
Updated Business Mailing Address July 09, 2007

Registered at 10750 S KNOLL CREST LN, TUCSON, AZ 857069052 (Tel: 5205742911)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as SHANNON CLARK

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Contractor (License #11816 in AZ)

🟢
Initial NPI Registration & Enumeration December 21, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1700940855
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 21, 2006
Last Update: December 26, 2024
Sole Proprietor: Yes

Mailing Address

12729 S Ox Cart Trl

Vail, AZ 856419232

Phone: 5122142841

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.