Active NPI
Lisa Shamblin
- Registered Nurse
- Charleston, WV
National Provider Identifier
1225634736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 30302
- Practice address
- 4510 Pennsylvania Ave
Charleston, WV 25302-4835 - Phone
- (304) 965-9081
- Fax
- (304) 471-2488
- NPI assigned
- Dec 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 30302 | WV | Primary |
Addresses
Primary practice location
4510 Pennsylvania Ave
Charleston, WV 25302-4835
Mailing address
11517 Elk River Rd N
Clendenin, WV 25045-6206
Phone (304) 389-9400
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | lshamblin@cwvasi.org | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607472000000",
"number": "1225634736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11517 ELK RIVER RD N",
"city": "CLENDENIN",
"state": "WV",
"postal_code": "250456206",
"telephone_number": "304-389-9400",
"fax_number": "304-471-2488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4510 PENNSYLVANIA AVE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253024835",
"telephone_number": "304-965-9081",
"fax_number": "304-471-2488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMBLIN",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-09",
"last_updated": "2020-12-09",
"certification_date": "2020-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WV",
"license": "30302",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "lshamblin@cwvasi.org",
"affiliation": "N",
"endpointDescription": "EMAIL",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "4510 Pennsylvania Ave",
"city": "Charleston",
"state": "WV",
"country_code": "US",
"postal_code": "253024835",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.