Provider Demographics
NPI:1043824501
Name:SHOCKLEY, CHRISTINA JEAN (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JEAN
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SIMS ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5148
Mailing Address - Country:US
Mailing Address - Phone:701-264-9049
Mailing Address - Fax:701-483-4781
Practice Address - Street 1:135 SIMS ST STE 202
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5148
Practice Address - Country:US
Practice Address - Phone:701-264-9049
Practice Address - Fax:701-483-4781
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33717207Q00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine