Provider Demographics
NPI:1144853581
Name:MOORLEGHEN, SHANNON MICHELLE (LAC)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MICHELLE
Last Name:MOORLEGHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2456
Mailing Address - Country:US
Mailing Address - Phone:423-928-9394
Mailing Address - Fax:
Practice Address - Street 1:113 E UNAKA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4085
Practice Address - Country:US
Practice Address - Phone:423-926-1237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist