Individual
KRISTA JO SHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
923 E CENTRAL AVE, LA FOLLETTE, TN 37766-2768
(423) 907-1200
(423) 907-1492
Mailing address
403 MYERS ST, JACKSBORO, TN 37757-2223
(423) 494-4717
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
35999
TN
Other
Enumeration date
04/03/2020
Last updated
04/03/2020
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