Basic Information
| Provider Information | |||||||||
| NPI: | 1013086735 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHULTS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | STAPLETON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9142 S NORTHSHORE DR | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379226325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656701560 | ||||||||
| FaxNumber: | 8656701862 | ||||||||
| Practice Location | |||||||||
| Address1: | 9142 S NORTHSHORE DR | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379226325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656701560 | ||||||||
| FaxNumber: | 8656701862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 24906 | TN | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3087409 | 05 | TN | MEDICAID |