Provider Demographics
NPI:1730546276
Name:SHOCKLEY, LEIGH ANNE (MSN-APRN)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNE
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:MSN-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-9388
Mailing Address - Country:US
Mailing Address - Phone:620-203-8440
Mailing Address - Fax:
Practice Address - Street 1:200 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:GURDON
Practice Address - State:AR
Practice Address - Zip Code:71743-1256
Practice Address - Country:US
Practice Address - Phone:870-353-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily