Provider Demographics
NPI:1184382053
Name:SHIPLEY, DESTINEE
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MADISON AVENUE
Mailing Address - Street 2:SUITE 447
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103
Mailing Address - Country:US
Mailing Address - Phone:901-448-3714
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVENUE
Practice Address - Street 2:SUITE 447
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-448-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2023-04-19
Deactivation Date:2023-04-03
Deactivation Code:
Reactivation Date:2023-04-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program