Individual
MRS. KARISSA V SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 OTIS SMITH DR, CLARKSVILLE, TN 37043-8940
(931) 553-6666
(931) 553-6681
Mailing address
111 OTIS SMITH DR, CLARKSVILLE, TN 37043-8940
(931) 553-6666
(931) 553-6681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6144
TN
363A00000X
Physician Assistant
PA1586
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100504311
—
NV
Enumeration date
02/17/2015
Last updated
10/07/2024
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