Provider Demographics
NPI:1578107181
Name:SHIPLEY, MARY CATHERINE ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:ELIZABETH
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 BRISTOL HWY
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-5208
Mailing Address - Country:US
Mailing Address - Phone:423-538-5202
Mailing Address - Fax:423-538-8208
Practice Address - Street 1:6419 BRISTOL HWY
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-5208
Practice Address - Country:US
Practice Address - Phone:423-538-5202
Practice Address - Fax:423-538-8208
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily