Provider Demographics
NPI:1407301724
Name:REDDICK, SHUNDRICKA ROCHELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHUNDRICKA
Middle Name:ROCHELLE
Last Name:REDDICK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7743
Mailing Address - Country:US
Mailing Address - Phone:870-692-7336
Mailing Address - Fax:
Practice Address - Street 1:407 S GOULD AVE
Practice Address - Street 2:
Practice Address - City:GOULD
Practice Address - State:AR
Practice Address - Zip Code:71643-5041
Practice Address - Country:US
Practice Address - Phone:870-263-4317
Practice Address - Fax:870-263-4782
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily