Provider Demographics
NPI:1053175661
Name:SHINABERRY, AUSTIN JORDAN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JORDAN
Last Name:SHINABERRY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 MEMPHIS ARLINGTON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-7439
Mailing Address - Country:US
Mailing Address - Phone:901-762-1531
Mailing Address - Fax:
Practice Address - Street 1:6490 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-7417
Practice Address - Country:US
Practice Address - Phone:901-762-1531
Practice Address - Fax:901-762-1532
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6705363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1750828968OtherURGENT CARE
TN1588116891OtherPRIMARY CARE