Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 22184 | WV |
N | 207Q00000X | Family Doctor | 35.075269 | OH |
Y | 207Q00000X | Family Doctor | 49699 | KY |
N | 207VX0000X | Obstetrician | 49699 | KY |
NPI | 1033179817 |
---|---|
Provider Name | Dr. Shannon K Bentley |
First Address | Edgewood, KY 41017-5446 |
Second Address | Edgewood, KY 41017-5446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100457110 | (05) | KY |
H18042 | (02) | |
K228150 | KY MEDICARE (01) | KY |