Healthcare Provider Details

I. General information

NPI: 1558316653
Provider Name (Legal Business Name): HEATHER T. SHOVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ADESA BLVD STE A100
LENOIR CITY TN
37771-6722
US

IV. Provider business mailing address

501 ADESA BLVD STE A100
LENOIR CITY TN
37771-6722
US

V. Phone/Fax

Practice location:
  • Phone: 865-422-4840
  • Fax: 888-440-7329
Mailing address:
  • Phone: 865-422-4840
  • Fax: 888-440-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA66044
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number71069
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: