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General NPI Number Information
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NPI Number | 1184123127
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Entity Type | Individual
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Provider Name | MARTINA ELAINE SHIRLEY BA
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Gender | Female
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 2210 GOLDSMITH LN STE 221B
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City | LOUISVILLE
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State | KY
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Zip | 40218-1082
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Country | US
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Telephone | 502-509-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 926 KINSER AVE
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1367
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Country | US
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Telephone | 502-509-4590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | KY
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