Provider Demographics
NPI:1851456974
Name:STOCKSDALE, SHILOH ANN (APRN)
Entity type:Individual
Prefix:MS
First Name:SHILOH
Middle Name:ANN
Last Name:STOCKSDALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26798
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2018
Mailing Address - Country:US
Mailing Address - Phone:888-488-8289
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:252 WHITTINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4904
Practice Address - Country:US
Practice Address - Phone:024-237-2465
Practice Address - Fax:024-267-2475
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002199A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01178334OtherRAILROAD MEDICARE
IN200857760Medicaid
IN255980001Medicare PIN
INM400052488Medicare PIN