Provider Demographics
NPI:1760520167
Name:SHANKLE, HEATHER MICHELLE (BS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:SHANKLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 VOLUNTEER PKWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-6808
Mailing Address - Country:US
Mailing Address - Phone:423-522-2200
Mailing Address - Fax:423-522-2180
Practice Address - Street 1:2540 VOLUNTEER PKWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-6808
Practice Address - Country:US
Practice Address - Phone:423-522-2200
Practice Address - Fax:423-522-2180
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health