Provider Demographics
NPI:1295082519
Name:SHAFFER, KIRA CLOA (PA-C)
Entity type:Individual
Prefix:MS
First Name:KIRA
Middle Name:CLOA
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:CLOA
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 HOWARD AVE STE B204
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4811
Mailing Address - Country:US
Mailing Address - Phone:814-369-1002
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE STE B204
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4811
Practice Address - Country:US
Practice Address - Phone:814-369-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055567363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033034900001Medicaid