| Doctor Name: | JOHNNY R SHUPE |
| NPI Number: | 1659495356 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN |
| License Number: | 0024151769 |
| Business Practice Address: | 373 Cecil D Quillen Dr Suite 101 Duffield, VA - 242444085 |
| Business Phone Number: | 2764311638 |
| Business Fax Number: | 2764311639 |
| Mailing Address: | 3609 Hemlock Park Dr, KINGSPORT |
| State: | TN |
| Postal Code: | 376632063 |
| Phone Number: | 4232393431 |
| Fax Number: | |
| NPI Enumeration Date: | 03/19/2007 |
| NPI Last Update Date: | 08/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024151769 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |