Provider Demographics
NPI:1467843011
Name:SHIELDS, KARISSA V (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:V
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 OTIS SMITH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8940
Mailing Address - Country:US
Mailing Address - Phone:931-553-6666
Mailing Address - Fax:931-553-6681
Practice Address - Street 1:111 OTIS SMITH DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8940
Practice Address - Country:US
Practice Address - Phone:931-553-6666
Practice Address - Fax:931-553-6681
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1586363A00000X
TN6144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504311Medicaid