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General NPI Number Information
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NPI Number | 1861217192
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Entity Type | Individual
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Provider Name | KASI LYNN SHOCK RN, CA-SANE
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Gender | Female
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 387 W IH 10
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City | FORT STOCKTON
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State | TX
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Zip | 79735-2708
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Country | US
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Telephone | 432-336-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 N OKLAHOMA ST
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City | FORT STOCKTON
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State | TX
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Zip | 79735-2631
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Country | US
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Telephone | 432-290-8970
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Fax |
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 1003645
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License Number State | TX
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