Provider Demographics
NPI:1821005968
Name:SHACKELFORD, LAURA ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 COLORADO VIS
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-8655
Mailing Address - Country:US
Mailing Address - Phone:903-746-0060
Mailing Address - Fax:
Practice Address - Street 1:2090 SMOKETREE AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-854-1800
Practice Address - Fax:928-854-1847
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX761981363LF0000X
FLARNP 9332948363LF0000X
PASP010856363LF0000X
AZAP5734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily