Provider Demographics
NPI:1740996255
Name:SHACKELFORD, LINDA GAIL (RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:GAIL
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 ST. GEORGE LANE
Mailing Address - Street 2:APT 5
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752
Mailing Address - Country:US
Mailing Address - Phone:606-670-7879
Mailing Address - Fax:
Practice Address - Street 1:670 W FIREWEED LN
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2562
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK180766163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse