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General NPI Number Information
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NPI Number | 1215388160
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Entity Type | Individual
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Provider Name | KEVIN J SHIVER FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 617 E BROAD ST STE B
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City | EUFAULA
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State | AL
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Zip | 36027-1710
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Country | US
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Telephone | 334-232-4368
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Fax |
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Provider Business Mailing Address
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Address Line | 2967 ROSS CLARK CIR
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City | DOTHAN
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State | AL
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Zip | 36301-1119
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Country | US
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Telephone | 334-305-2085
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-154991
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN135083
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License Number State | AL
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