Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD39481 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | MD39481 | TN |
NPI | 1093743254 |
---|---|
Provider Name | Dr. Kristen P. Sheets |
First Address | Maryville, TN 37801-7897 |
Second Address | Knoxville, TN 37916-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4107154 | BLUE CROSS (01) | TN |
5440613 | (05) | TN |
64104151 | (05) | KY |