Provider Demographics
NPI:1679706469
Name:SHOCKEY, SANDRA KATHRYN (APRN (C/NP))
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KATHRYN
Last Name:SHOCKEY
Suffix:
Gender:F
Credentials:APRN (C/NP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2720
Mailing Address - Country:US
Mailing Address - Phone:304-893-7000
Mailing Address - Fax:
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE 11
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-916-1270
Practice Address - Fax:304-916-1274
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38437163WP2201X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily