Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3006402 | KY |
NPI | 1003121393 |
---|---|
Provider Name | Mrs. Shay Lynn Kirk |
First Address | Cincinnati, OH 45263-6961 |
Second Address | Paducah, KY 42003-7914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2010 |
Last Update Date | 19/08/2015 |