Provider Demographics
NPI:1265530620
Name:SHAMBLIN, JESSICA CLAIRE (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CLAIRE
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CLAIRE
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:988 OAK RIDGE TPKE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6919
Mailing Address - Country:US
Mailing Address - Phone:865-483-4366
Mailing Address - Fax:
Practice Address - Street 1:988 OAK RIDGE TPKE STE 200
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6919
Practice Address - Country:US
Practice Address - Phone:865-483-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ048117Medicaid
TN33438181Medicaid
TN4155652OtherBCBST
3703867Medicare PIN
33438181Medicare PIN
3703865Medicare PIN