Provider Demographics
NPI:1629185715
Name:SHOCKEY, CANDACE RAE (NP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:RAE
Last Name:SHOCKEY
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 1:8015 W ALAMEDA AVE
Mailing Address - Street 2:#210
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-742-0108
Mailing Address - Fax:303-742-0690
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:#210
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-742-0108
Practice Address - Fax:303-742-0690
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79280363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32086245Medicaid
CO32086245Medicaid
C491118Medicare ID - Type Unspecified