Healthcare Provider Details

I. General information

NPI: 1689592297
Provider Name (Legal Business Name): SHANE D. VORE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S ROAN ST STE 435
JOHNSON CITY TN
37601-7587
US

IV. Provider business mailing address

2700 S ROAN ST STE 435
JOHNSON CITY TN
37601-7587
US

V. Phone/Fax

Practice location:
  • Phone: 765-513-6311
  • Fax:
Mailing address:
  • Phone: 765-513-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42381
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: