Shannon Lacey Doherty, LAT, ATC
Individual provider Active NPI Athletic Trainer · Diboll, TX
NPI 1972189470 · NPPES record last updated Mar 23, 2021
Key facts
- NPI
- 1972189470
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT8340 (TX)
- Practice address
- 1000 Lumberjack Dr
Diboll, TX 75941-9701 - Phone
- (936) 829-5626
- NPI assigned
- Mar 23, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT8340 | TX | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT8340 | TX | Yes |
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
Other providers in Diboll, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.