Healthcare Provider Details

I. General information

NPI: 1861499691
Provider Name (Legal Business Name): ELIZABETH ANN SHOCKLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18877 JEB STUART HWY
STUART VA
24171-5223
US

IV. Provider business mailing address

18981 JEB STUART HWY
STUART VA
24171-5146
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4466
  • Fax:
Mailing address:
  • Phone: 276-694-4416
  • Fax: 276-694-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024164686
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010297
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010297
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00241646863
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: