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General NPI Number Information
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NPI Number | 1073987921
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Entity Type | Individual
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Provider Name | SHANA INGLE
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Gender | Female
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 1550 BECKWITH RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-5104
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Country | US
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Telephone | 615-582-4595
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Fax | 615-447-5981
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Provider Business Mailing Address
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Address Line | 1550 BECKWITH RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-5104
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Country | US
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Telephone | 615-582-4595
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Fax | 615-447-5981
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | L000000017073
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License Number State | TN
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