Shannon Jackie Clark
NPI 1700940855ActiveIndividual· Contractor· Vail, AZ
Contractor in Vail, Arizona, licensed in AZ, with an NPI issued in December 2006.
Overview
| NPI | 1700940855 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Dec 21, 2006 |
| Last updated in NPPES | Dec 26, 2024 |
| Certified by provider | Dec 26, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Contractor Primary | 171W00000X | 11816 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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