Provider Demographics
NPI:1396048906
Name:SHINKLE, COLBY P (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:COLBY
Middle Name:P
Last Name:SHINKLE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3018 N ROCK BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-8780
Mailing Address - Country:US
Mailing Address - Phone:316-640-2791
Mailing Address - Fax:
Practice Address - Street 1:527 N GROVE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4520
Practice Address - Country:US
Practice Address - Phone:316-262-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians