Provider Demographics
NPI:1043686371
Name:MILBY, SHAUN (APRN)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:
Last Name:MILBY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 RING RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5929
Mailing Address - Country:US
Mailing Address - Phone:270-706-1925
Mailing Address - Fax:270-706-1926
Practice Address - Street 1:2411 RING RD
Practice Address - Street 2:SUITE 114
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5929
Practice Address - Country:US
Practice Address - Phone:270-706-1925
Practice Address - Fax:270-706-1926
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily