MEDICARE: MERCY GRACE SHIRK LCPM

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	176B00000X	Midwife	4023113	KY

General Provider Information

NPI Number	:	1972345957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCY GRACE SHIRK LCPM

Provider Business Mailing Address
First Line	:	7364 HIGHWAY 910
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-9702
Country	:	US
Telephone Number	:	502-382-7162
Fax Number	:

Provider Business Practice Location Address
First Line	:	7364 HIGHWAY 910
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-9702
Country	:	US
Telephone Number	:	502-382-7162
Fax Number	:

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

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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Directions to “ MERCY GRACE SHIRK LCPM” Practice Location

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