Individual
JARREL LYNNE SHACKLEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1814 NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5350
(910) 662-8765
(910) 362-9123
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 662-8765
(910) 362-9123
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12100
NC
363A00000X
Physician Assistant
PA00580
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548559099
NEIGHBORHOOD HEALTH PLAN
RI
01
—
4744074
AETNA
RI
Enumeration date
04/05/2011
Last updated
06/01/2022
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