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Individual

MRS. ALLISON LAYNE SHAMBLIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
15 STONEBRIDGE BLVD, JACKSON, TN 38305-2042
(731) 660-2056
Mailing address
15 STONEBRIDGE BLVD, JACKSON, TN 38305-2042

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1939
TN
363A00000X
Physician Assistant
PA05500
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
192433402
TX
01
8Y3249
BCBS
TX
01
8Y8266
BCBSTX
TX
Enumeration date
11/06/2007
Last updated
03/14/2011
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