Jennifer Gordon Shafer, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO2150 Issued in TN

Practice address

2033 Meadowview LN
Ste 200
Kingsport, TN 37660-7569

Phone

(423) 857-2260

Fax

(423) 857-2261

NPI assigned

Aug 31, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1134313265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "telephone_number": "423-857-2066",
            "fax_number": "423-857-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 MEADOWVIEW LN",
            "address_2": "STE 200",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376607569",
            "telephone_number": "423-857-2260",
            "fax_number": "423-857-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFER",
        "first_name": "JENNIFER",
        "middle_name": "GORDON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-31",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "DO2150",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2009-01172",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521048",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Dawn Seluk, D.O.
• Senior House Management
• Serene Roots Wellness LLC
• David H Sewell, M. D.
• Brian David Shafer, D.O.
• Logan Alexander Shaffer, LPC-MHSP
• Fereidoon Shafiei, MD
• Aruna Shah, MD
• Neesha Nalina Shah, MSN, FNP
• Stacy Rebekah Shankle, BS

• Family Medicine Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.