Individual ProviderJennifer Gordon ShaferFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address2033 Meadowview Ln, Ste 200, Kingsport, TN 37660-7569(423) 857-2260(423) 857-2066PECOS EnrollmentBased on the most recent information from CMS, provider Jennifer Gordon Shafer does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1134313265Provider TypeIndividualFull NameShafer, Jennifer GordonCredentialD.O.GenderFemaleSole ProprietorNoEnumeration Date8/31/2007Last Updated2/2/2012Contact InformationPractice LocationPractice Address2033 Meadowview Ln, Ste 200, Kingsport, TN 37660-7569Phone(423) 857-2260Fax(423) 857-2261Mailing LocationMailing AddressPO Box 9, Kingsport, TN 37662-0009Phone(423) 857-2066Fax(423) 857-2070Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseDO2150TennesseeCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense2009-01172North CarolinaProvider IdentifiersIDDescriptionIssuerID1521048DescriptionMedicaidIssuerUnlistedTennessee