Healthcare Provider Details

I. General information

NPI: 1912234535
Provider Name (Legal Business Name): TAMERON C SHAW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMERON ZILISCH

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST STE 101
BROWNSVILLE KY
42210-9001
US

IV. Provider business mailing address

PO BOX 784
BROWNSVILLE KY
42210-0784
US

V. Phone/Fax

Practice location:
  • Phone: 270-975-4050
  • Fax:
Mailing address:
  • Phone: 270-975-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006230
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: