=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669921888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN RIPLEY SHOTWELL PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2016
-----------------------------------------------------
Last Update Date | 09/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1932 ALCOA HWY 475-C
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-305-5000
-----------------------------------------------------
Fax | 865-305-5001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1932 ALCOA HWY 475-C
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-305-5000
-----------------------------------------------------
Fax | 865-305-5001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 3086
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------