Provider Demographics
NPI:1528208774
Name:SHAMBLIN, LUCY KARA (DO)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:KARA
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PINNELL ST STE D
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-9105
Mailing Address - Country:US
Mailing Address - Phone:304-372-1740
Mailing Address - Fax:304-372-3069
Practice Address - Street 1:174 PINNELL ST STE D
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9105
Practice Address - Country:US
Practice Address - Phone:304-372-1740
Practice Address - Fax:304-372-3069
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2473207KA0200X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024964Medicaid
WV003577627OtherUHC MPIN
WVWV2180GOtherMEDICAARE PTAN
WVWV2080HOtherMEDICARE PTAN
WVWV2180EOtherMEDICARE PTAN
WVWV2180DOtherMEDICARE PTAN
WVWV2180FOtherMEDICARE PTAN