Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Shannon Jackie Clark

Individual provider Contractor · NPI 1700940855

Mrs. Shannon Jackie Clark is a Contractor in Vail, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2006
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Practice location Address checks out

12729 S Ox Cart Trl
Vail, AZ 85641-9232
Phone: (512) 214-2841
Fax: (520) 750-0056
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Contractor (primary) Taxonomy 171W00000X · Licence 11816 (AZ)

Record details

NPI number1700940855
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedDecember 21, 2006
Last updated in NPPESDecember 26, 2024
Certification dateDecember 26, 2024

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