Provider Demographics
NPI:1952566838
Name:SHACKELFORD, SOMMER KOLANDER (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:SOMMER
Middle Name:KOLANDER
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:SOMMER
Other - Middle Name:BROOKE
Other - Last Name:KOLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:8155 GLADYS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3244
Mailing Address - Country:US
Mailing Address - Phone:409-673-1796
Mailing Address - Fax:409-247-2178
Practice Address - Street 1:8155 GLADYS AVE STE 102
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3244
Practice Address - Country:US
Practice Address - Phone:409-673-1796
Practice Address - Fax:409-247-2178
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily