Provider Demographics
NPI:1083148332
Name:SHOCKLEY, TRISHA (RN)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 COUNTY ROAD 2311
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-3748
Mailing Address - Country:US
Mailing Address - Phone:903-787-0330
Mailing Address - Fax:
Practice Address - Street 1:304 COUNTY ROAD 2311
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-3748
Practice Address - Country:US
Practice Address - Phone:903-787-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640348163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant