Provider Demographics
NPI:1255425823
Name:SHIPLEY, LORI L (PA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEDICAL PARK
Mailing Address - Street 2:SUITE 219
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-7160
Mailing Address - Fax:304-243-6372
Practice Address - Street 1:30 MEDICAL PARK
Practice Address - Street 2:SUITE 219
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-7160
Practice Address - Fax:304-243-6372
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01083363A00000X
WV1083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081006Medicaid
WVSHPA78251Medicare ID - Type Unspecified