Provider Demographics
NPI:1568642692
Name:SHAMBLIN, ALLISON LAYNE (PA)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:LAYNE
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:LAYNE
Other - Last Name:HOGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2042
Practice Address - Country:US
Practice Address - Phone:731-660-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1939363A00000X
TXPA05500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192433402Medicaid
TX8Y8266OtherBCBSTX
TX8Y3249OtherBCBS
TX8Y8266OtherBCBSTX
TX192433402Medicaid