Provider Demographics
NPI:1114565884
Name:SHAFER, RACHEL KAYE (MSN, APRN, AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:KAYE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KAYE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3101
Mailing Address - Country:US
Mailing Address - Phone:361-580-5195
Mailing Address - Fax:361-572-9320
Practice Address - Street 1:102 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3101
Practice Address - Country:US
Practice Address - Phone:361-580-5195
Practice Address - Fax:361-572-9320
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144249363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology