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

Shannon Lee Ruth Dieffenderfer

Individual provider Physician Assistant · NPI 1861048530

Shannon Lee Ruth Dieffenderfer is a Physician Assistant in Anchorage, Alaska. Graduated from Philadelphia Col of Osteo Med, Sewanee in 2020, 6 years ago. Practices with Tanana Valley Clinic LLC, a 142-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Alaska and Georgia.

Years since qualifying
6
Trained at
Philadelphia Col of Osteo Med, Sewanee
Licensed in
AK, GA
In the registry since
2019
Specialties on file
3
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Practice location Address checks out

4100 Lake Otis Pkwy Ste 108
Anchorage, AK 99508-5230
Phone: (907) 563-3145
Fax: (907) 561-3967
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 187 Glenn Hwy, Glennallen, AK 99588-0005 — (907) 822-5686

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 172156 (AK)
Physician Assistant Taxonomy 363A00000X · Licence 10117 (GA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (GA)

Record details

NPI number1861048530
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 17, 2019
Last updated in NPPESJune 6, 2022
Certification dateJune 6, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolPHILADELPHIA COL OF OSTEO MED, SEWANEE
Graduated 2020 (6 years in practice)
Group practice Tanana Valley Clinic Llc — 142 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Anchorage