Healthcare Provider Details

I. General information

NPI: 1205816014
Provider Name (Legal Business Name): ALBEN B. SHOCKLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N GARDENMILE RD
HENDERSON KY
42420-5543
US

IV. Provider business mailing address

2211 MAYFAIR DR SUITE 101
OWENSBORO KY
42301-4568
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-6030
  • Fax: 812-485-6032
Mailing address:
  • Phone: 270-688-1352
  • Fax: 270-683-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26126
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01036897A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: