Provider Demographics
NPI:1326009101
Name:SHILLING, JAMES M (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:SHILLING
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8601
Mailing Address - Country:US
Mailing Address - Phone:606-877-3931
Mailing Address - Fax:606-877-3978
Practice Address - Street 1:310 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1204
Practice Address - Country:US
Practice Address - Phone:606-877-3931
Practice Address - Fax:606-877-3978
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY709A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50009629OtherPASSPORT HEALTH PLAN
KYC20356OtherCUMBERLAND HEALTHCARE INC
KY000000390578OtherANTHEM
KY74007097Medicaid
KY74007097Medicaid