JENNIFER K SHOCKLIE (MSN, RN, PMHNP-BC) – Licensed Practical Nurse, NPI 1265674121
Licensed Practical Nurse
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,379 NURSE PRACTITIONER in OR
Provider Addresses for JENNIFER K SHOCKLIE (MSN, RN, PMHNP-BC)
5401 N 104TH DR
GLENDALE, AZ 853074192
Phone: (623) 691-5015
Fax: (623) 691-5020
Type: Mailing
535 SE WASHINGTON ST
HILLSBORO, OR 971234142
Phone: (503) 755-6703
Fax: (503) 755-6704
Type: Location
5401 N 104th Dr
Glendale, AZ 853074192
Phone: (623) 252-8004
Type: Location
395 SW Bluff Dr Ste 10
Bend, OR 977021670
Phone: (503) 755-6703
Fax: (503) 755-6704
Type: Location
Frank Borman Middle School, 3637, North 55th Avenue, Phoenix, Maricopa County, Arizona, 85031-2607, United States
PHOENIX, AZ 850312503
Phone: (623) 691-5015
Fax: (623) 691-5020
Type: Mailing
5441 S MACADAM AVE STE N
PORTLAND, OR 972393822
Phone: (503) 707-1053
Fax: (541) 512-6127
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241108002376 | I | Nurse Practitioner | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 85307)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OR | |
| Nurse Practitioner | WI | |
| Nurse Practitioner | AZ | |
| Nurse Practitioner | OR | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | WI | |
| Nurse Practitioner | SC | |
| Nurse Practitioner | OR |
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