Provider Demographics
NPI:1144237033
Name:SHOOK, ALICE WARD (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:WARD
Last Name:SHOOK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 LORENA LN
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4493
Mailing Address - Country:US
Mailing Address - Phone:865-617-1356
Mailing Address - Fax:
Practice Address - Street 1:106 HOLT CT
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-6917
Practice Address - Country:US
Practice Address - Phone:423-444-5838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000143255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506054Medicaid
TN39280002Medicare UPIN