Provider Demographics
NPI:1821007527
Name:SHACKELFORD, DEBORAH H (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:H
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 1:2907 BRIGADOON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1308
Mailing Address - Country:US
Mailing Address - Phone:859-276-7959
Mailing Address - Fax:859-276-7911
Practice Address - Street 1:1801 EDISON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1359
Practice Address - Country:US
Practice Address - Phone:859-276-7959
Practice Address - Fax:859-276-7911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4676P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily