MEDICARE: KIEGAN SHACKLETON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		NV

General Provider Information

NPI Number	:	1215888730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIEGAN SHACKLETON

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 ALTAMIRA DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-1520
Country	:	US
Telephone Number	:	530-314-1971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ KIEGAN SHACKLETON ” Practice Location

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