Provider Demographics
NPI:1902632714
Name:SHACKLETON, RACHELLE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:
Last Name:SHACKLETON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 TIMBER DR STE 275
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2571
Mailing Address - Country:US
Mailing Address - Phone:919-262-4823
Mailing Address - Fax:
Practice Address - Street 1:2664 TIMBER DR STE 275
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2571
Practice Address - Country:US
Practice Address - Phone:919-262-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025021853363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health