| NPI | 1861594087 |
|---|---|
| Former Name | JENA L SHACKELFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2014036816) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS T-00770) |
| 363A00000X Physician Assistant (Licence: IN 10001223A) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2014-12-05 |