MRS. COLLEEN M SHACKELFORD NP NPI 1104107317

NPI Information

NPI: 1104107317
Provider Name: MRS. COLLEEN M SHACKELFORD, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
300 E BANNOCK ST
BOISE, ID
ZIP 83712
Phone: (208) 342-7400
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MRS. Colleen M Shackelford, NP is a family nurse practitioner in Boise, ID. MRS. Colleen M Shackelford, NP NPI is 1104107317. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

300 E BANNOCK ST
BOISE, ID
ZIP 83712-207
Phone: (208) 342-7400
Fax: (208) 342-1879

The NPI 1104107317 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/31/2011 and was last updated on 10/4/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		N-41423	IDAHO	No
2	363LF0000X	Nurse Practitioner	Family	NP-1127A	IDAHO	No
3	363LF0000X	Nurse Practitioner	Family	NP1127A	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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