Healthcare Provider Details

I. General information

NPI: 1033051644
Provider Name (Legal Business Name): SHIANNE SUMER MILBOURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SR-33
NEW TAZEWELL TN
37825
US

IV. Provider business mailing address

2257 JACKBORO PIKE
LAFOLLETTE TN
37766
US

V. Phone/Fax

Practice location:
  • Phone: 423-562-4766
  • Fax:
Mailing address:
  • Phone: 423-562-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: