Provider Demographics
NPI:1861747024
Name:SHEKARCHI, JACQUELYN CONAWAY (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:CONAWAY
Last Name:SHEKARCHI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 GARDEN PARK DR APT 415
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3761
Mailing Address - Country:US
Mailing Address - Phone:210-422-9540
Mailing Address - Fax:
Practice Address - Street 1:1920 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3936
Practice Address - Country:US
Practice Address - Phone:817-702-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122031363LP0200X
TX658583363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics