Provider Demographics
NPI:1700810371
Name:SHIPLEY, DIANNA L (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:
Practice Address - Street 1:225 BIG STATION CAMP BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-8464
Practice Address - Country:US
Practice Address - Phone:615-451-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31460207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3124944OtherBCBS OF TN
900002579OtherRAILROAD MEDICARE
3640000OtherUNITED HEALTHCARE
5794103OtherAETNA
KY64722010Medicaid
TN3838505Medicaid
3124944OtherBCBS OF TN
F79380Medicare UPIN