Basic Information
| Provider Information | |||||||||
| NPI: | 1780154245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHELBURNE | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 ANDOVER CT | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376633087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767086956 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 W STONE DR | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376602360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232464961 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | F11180841 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.