Provider Demographics
NPI:1669107538
Name:TOMBLINSON, SHAYE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHAYE
Middle Name:
Last Name:TOMBLINSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 HUNTSVILLE QUALITY RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-7395
Mailing Address - Country:US
Mailing Address - Phone:270-516-1601
Mailing Address - Fax:270-934-2108
Practice Address - Street 1:263 HUNTSVILLE QUALITY RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-7395
Practice Address - Country:US
Practice Address - Phone:270-516-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26201363LF0000X
KY3017925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily