Healthcare Provider Details

I. General information

NPI: 1649240979
Provider Name (Legal Business Name): THOMAS BERNARD SHIELDS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BROOKHAVEN RD
FRANKLIN KY
42134-2745
US

IV. Provider business mailing address

1030 BROOKHAVEN RD PO BOX 346
FRANKLIN KY
42135-0346
US

V. Phone/Fax

Practice location:
  • Phone: 270-586-1800
  • Fax:
Mailing address:
  • Phone: 270-586-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA093798
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6167
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: