Active NPI
Shannon Lacey Doherty, LAT, ATC
- Athletic Trainer
- Diboll, TX
National Provider Identifier
1972189470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT8340
- Practice address
- 1000 Lumberjack Dr
Diboll, TX 75941-9701 - Phone
- (936) 829-5626
- NPI assigned
- Mar 23, 2021
- Last updated
- Mar 23, 2021
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT8340 | TX | Primary |
Addresses
Primary practice location
1000 Lumberjack Dr
Diboll, TX 75941-9701
Mailing address
2807 Daniel McCall Dr Apt 223
Lufkin, TX 75904-7151
Phone (303) 990-1945
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT8340 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616457600000",
"number": "1972189470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2807 DANIEL MCCALL DR APT 223",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759047151",
"telephone_number": "303-990-1945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 LUMBERJACK DR",
"city": "DIBOLL",
"state": "TX",
"postal_code": "759419701",
"telephone_number": "936-829-5626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "SHANNON",
"middle_name": "LACEY",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-23",
"last_updated": "2021-03-23",
"certification_date": "2021-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT8340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Diboll, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.