Provider Demographics
NPI:1740834993
Name:CROCKETT, SHAKISHA (MSN,FNP-C)
Entity type:Individual
Prefix:
First Name:SHAKISHA
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5228
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4102 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1122
Practice Address - Country:US
Practice Address - Phone:806-725-0237
Practice Address - Fax:806-725-1030
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141546363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics