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General NPI Number Information
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NPI Number | 1225604275
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Entity Type | Individual
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Provider Name | KIRSTEN SHEW
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Gender | Female
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 1680 S JEFFERSON AVE
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City | COOKEVILLE
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State | TN
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Zip | 38506-2526
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Country | US
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Telephone | 931-288-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 107 MEADOWLAND DR
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City | MANCHESTER
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State | TN
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Zip | 37355-3778
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | TN
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