Individual
LISA L SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
135 W RAVINE RD, STE 5B, KINGSPORT, TN 37660-3847
(423) 224-3460
(423) 224-3465
Mailing address
PO BOX 1308, KINGSPORT, TN 37662-1308
(423) 224-3460
(423) 224-3465
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
22142
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00013859
NHC CARE ADMINISTRATORS
—
01
—
031807
ANTHEM BCBS
—
01
—
050046532
RAILROAD MEDICARE
—
01
—
100010226
PHP TENNCARE
—
01
—
3045909
BLUE SHIELD OF TN
—
05
—
3066975
—
TN
05
—
5736099
—
VA
05
—
64911829
—
KY
05
—
890575L
—
NC
01
—
TN0100
JOHN DEERE
—
Enumeration date
08/10/2005
Last updated
06/26/2008
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