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General NPI Number Information
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NPI Number | 1003872623
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Entity Type | Individual
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Provider Name | SHELLY J MCINTOSH FNP
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Gender | Female
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Dates
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Enumeration Date | 04/22/2006
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Last Update Date | 05/02/2020
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Provider Practice Location Address
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Address Line | 301 MED TECH PKWY SUITE 240
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2364
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Country | US
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Telephone | 423-794-5520
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Fax | 423-282-0720
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Provider Business Mailing Address
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Address Line | 215 E SPRINGBROOK DR
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1761
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Country | US
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Telephone | 423-794-5520
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Fax | 423-282-6940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN127044
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN12000
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License Number State | TN
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