Healthcare Provider Details

I. General information

NPI: 1114493236
Provider Name (Legal Business Name): ELISE SHANKLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 IRA E WOODS AVE
GRAPEVINE TX
76051-4213
US

IV. Provider business mailing address

3701 IRA E WOODS AVE
GRAPEVINE TX
76051-4213
US

V. Phone/Fax

Practice location:
  • Phone: 817-251-2501
  • Fax:
Mailing address:
  • Phone: 817-251-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139106
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: