Basic Information
| Provider Information | |||||||||
| NPI: | 1700810371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIPLEY | ||||||||
| FirstName: | DIANNA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 440100 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372440100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153290570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 BIG STATION CAMP BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370668464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154515481 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 31460 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3124944 | 01 | BCBS OF TN | OTHER | 900002579 | 01 | RAILROAD MEDICARE | OTHER | 3640000 | 01 | UNITED HEALTHCARE | OTHER | 5794103 | 01 | AETNA | OTHER | 64722010 | 05 | KY | MEDICAID | 3838505 | 05 | TN | MEDICAID |