MEDICARE: SHUNIQUA HALKMON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1124701859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUNIQUA HALKMON

Provider Business Mailing Address
First Line	:	PO BOX 100373
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-0373
Country	:	US
Telephone Number	:	817-915-3033
Fax Number	:

Provider Business Practice Location Address
First Line	:	9009 HORSE HERD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3072
Country	:	US
Telephone Number	:	817-915-3033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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Directions to “ SHUNIQUA HALKMON ” Practice Location

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