Provider Demographics
NPI:1043325558
Name:SHIGENO, KEIKO J (APRN, BC)
Entity Type:Individual
Prefix:
First Name:KEIKO
Middle Name:J
Last Name:SHIGENO
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 STONE HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2089
Mailing Address - Country:US
Mailing Address - Phone:615-403-4831
Mailing Address - Fax:615-391-1827
Practice Address - Street 1:5148A MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2712
Practice Address - Country:US
Practice Address - Phone:615-641-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB0834843OtherDEA
P44601Medicare UPIN