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General NPI Number Information
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NPI Number | 1265674121
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Entity Type | Individual
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Provider Name | JENNIFER K SHOCKLIE MSN, RN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 10/06/2024
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Provider Practice Location Address
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Address Line | 535 SE WASHINGTON ST
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City | HILLSBORO
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State | OR
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Zip | 97123-4142
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Country | US
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Telephone | 503-755-6703
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Fax | 503-755-6704
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Provider Business Mailing Address
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Address Line | 5401 N 104TH DR
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City | GLENDALE
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State | AZ
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Zip | 85307-4192
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Country | US
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Telephone | 623-691-5015
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Fax | 623-691-5020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN199413
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10031539
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License Number State | OR
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