Provider Demographics
NPI:1477992659
Name:SHOOK, MINDY LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:LYNN
Last Name:SHOOK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:LYNN
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 19036
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4085
Mailing Address - Country:US
Mailing Address - Phone:903-232-1622
Mailing Address - Fax:903-753-0760
Practice Address - Street 1:802 MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5204
Practice Address - Country:US
Practice Address - Phone:903-232-1622
Practice Address - Fax:903-753-0760
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily