Provider Demographics
NPI:1346720604
Name:SHIFFLETT, LAURA WILKERSON (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:WILKERSON
Last Name:SHIFFLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-713-4100
Mailing Address - Fax:757-578-8587
Practice Address - Street 1:13737 SPOTSWOOD TRL
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-3200
Practice Address - Country:US
Practice Address - Phone:540-713-4100
Practice Address - Fax:757-578-8587
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPENDINGMedicaid