=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851373500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN T. SHINE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2005
-----------------------------------------------------
Last Update Date | 02/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E 15TH AVE
-----------------------------------------------------
City | GULF SHORES
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36542-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-962-1250
-----------------------------------------------------
Fax | 251-967-7832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 E 15TH AVE
-----------------------------------------------------
City | GULF SHORES
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36542-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-949-3479
-----------------------------------------------------
Fax | 251-949-3434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD.15964
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------