Healthcare Provider Details

I. General information

NPI: 1417934621
Provider Name (Legal Business Name): SHANE M HIRST CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MAYSVILLE RD # A
MOUNT STERLING KY
40353-9767
US

IV. Provider business mailing address

236 W MAIN ST
MOUNT STERLING KY
40353-1348
US

V. Phone/Fax

Practice location:
  • Phone: 859-498-2323
  • Fax: 859-498-7314
Mailing address:
  • Phone: 859-404-7686
  • Fax: 859-274-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3014355
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number09000117A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28140700A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: