Provider Demographics
NPI:1427095751
Name:SHORT, DAWN (FNP)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:417 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-6904
Practice Address - Country:US
Practice Address - Phone:276-328-7071
Practice Address - Fax:276-328-6082
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004942Medicaid
VA010044758Medicaid
V V5993AMedicare PIN
VA010044758Medicaid
VA004013W84Medicare PIN
P64923Medicare UPIN