Provider Demographics
NPI:1245612506
Name:HUSKEY, SHAMIKA (NP-C)
Entity type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WALTER REED DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1128
Mailing Address - Country:US
Mailing Address - Phone:336-832-9700
Mailing Address - Fax:336-832-9614
Practice Address - Street 1:200 MEDICAL PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0939
Practice Address - Country:US
Practice Address - Phone:704-786-1108
Practice Address - Fax:704-782-1826
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2021-11-29
Deactivation Date:2021-11-11
Deactivation Code:
Reactivation Date:2021-11-28
Provider Licenses
StateLicense IDTaxonomies
NC5007699363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2097433Medicaid