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NPI Code Detail

MEDICARE: MASON M. SHIVES

MEDICARE: MASON M. SHIVES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3014190KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699306811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MASON M. SHIVES
Provider Business Mailing Address
First Line : 201 PARK ST
Second Line :
City : BOWLING GREEN
State : KY
Zip : 42101-1708
Country : US
Telephone Number : 270-781-5111
Fax Number :
Provider Business Practice Location Address
First Line : 405 S L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1725
Country : US
Telephone Number : 270-794-0260
Fax Number : 270-361-5001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2020
Last Update Date : 06/23/2022

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