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General NPI Number Information
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NPI Number | 1336379544
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Entity Type | Organization
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Legal Business Name | ROCKCASTLE PEDIATRICS & ADOLESCENTS PSC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 02/16/2013
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Provider Practice Location Address
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Address Line | 140 NEWCOMB AVE
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City | MOUNT VERNON
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State | KY
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Zip | 40456-2728
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Country | US
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Telephone | 606-256-4148
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Fax | 606-256-7785
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Provider Business Mailing Address
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Address Line | PO BOX 1020
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City | MOUNT VERNON
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State | KY
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Zip | 40456-1020
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Country | US
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Telephone | 606-256-4148
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Fax | 606-256-7785
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Authorized Official
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Title or Position | OWNER
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Name | CALLIE SHAFFER
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Credential | M.D.
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Telephone | 606-256-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | KY
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