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General NPI Number Information
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NPI Number | 1417934621
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Entity Type | Individual
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Provider Name | SHANE M HIRST CNM
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Gender | Female
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 635 MAYSVILLE RD # A
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City | MOUNT STERLING
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State | KY
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Zip | 40353-9767
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Country | US
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Telephone | 859-498-2323
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Fax | 859-498-7314
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Provider Business Mailing Address
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Address Line | 236 W MAIN ST
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City | MOUNT STERLING
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State | KY
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Zip | 40353-1348
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Country | US
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Telephone | 859-404-7686
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Fax | 859-274-4312
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 09000117A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 28140700A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 3014355
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License Number State | KY
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