MEDICARE: SHIHCHIN CHANG APRN

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	363LF0000X	Family Nurse Practitioner	3013763	KY

General Provider Information

NPI Number	:	1407403629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIHCHIN CHANG APRN

Provider Business Mailing Address
First Line	:	201 PARK ST
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1742
Country	:	US
Telephone Number	:	270-781-0167
Fax Number	:	270-781-7112

Provider Business Practice Location Address
First Line	:	1402 ANDREA ST
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-3336
Country	:	US
Telephone Number	:	270-781-0167
Fax Number	:	270-781-7112

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

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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Directions to “ SHIHCHIN CHANG APRN” Practice Location

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