Provider Demographics
NPI:1750055547
Name:STARKEY, SHANNON (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:STARKEY
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 WYOMING BLVD NE STE F1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3983
Mailing Address - Country:US
Mailing Address - Phone:505-807-3086
Mailing Address - Fax:
Practice Address - Street 1:7007 WYOMING BLVD NE STE F1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3983
Practice Address - Country:US
Practice Address - Phone:505-807-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM64592363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty