Provider Demographics
NPI:1619464484
Name:SNELLING, SHAKERA KATHLEEN (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAKERA
Middle Name:KATHLEEN
Last Name:SNELLING
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 GOLDEN PKWY STE B443
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5842
Mailing Address - Country:US
Mailing Address - Phone:205-582-7636
Mailing Address - Fax:
Practice Address - Street 1:3617 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4667
Practice Address - Country:US
Practice Address - Phone:205-582-7636
Practice Address - Fax:205-273-2037
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008838363LP0808X
FLAPRN11019193363LP0808X
AZ295361363LP0808X
GARN281498363LP0808X
MO2022033070363LF0000X
MO2022033033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily