Provider Demographics
NPI:1184267049
Name:SHOCKEY, NICCOLE MARIE (APRN)
Entity type:Individual
Prefix:MS
First Name:NICCOLE
Middle Name:MARIE
Last Name:SHOCKEY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 HIGHWAY 9 STE A
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-7195
Mailing Address - Country:US
Mailing Address - Phone:864-764-1050
Mailing Address - Fax:
Practice Address - Street 1:5535 HIGHWAY 9 STE A
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-7195
Practice Address - Country:US
Practice Address - Phone:864-764-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23532363LF0000X
SC251786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily