Shockley, Lisa L

Shockley, Lisa L is an individual health care provider with primary practice located at 135 W Ravine Rd Ste 5B, Kingsport TN 37660-3847. She recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as her primary health care specialty. Shockley, Lisa L can be contacted via phone (423) 224-3460.

Contact Information

Primary practice address
135 W Ravine Rd Ste 5B Kingsport TN 37660-3847
Phone: (423) 224-3460
Fax: (423) 224-3465
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 22142 Tennessee

Profile Details

NPI number 1720089873
LBN Legal business name Shockley, Lisa L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Jun 26th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720089873 NPPES
Other 031807 ANTHEM BCBS
MEDICAID 5736099 ANTHEM BCBS
MEDICAID 64911829 ANTHEM BCBS
Other 3045909 ANTHEM BCBS
MEDICAID 3066975 ANTHEM BCBS
Other 00013859 ANTHEM BCBS
Other 100010226 ANTHEM BCBS
MEDICAID 890575L ANTHEM BCBS
Other 050046532 ANTHEM BCBS
Other TN0100 ANTHEM BCBS

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