Provider Demographics
NPI:1356453872
Name:SHORT, SHEILA KAY (APRN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:KAY
Last Name:SHORT
Suffix:
Gender:F
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:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:60 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9644
Practice Address - Country:US
Practice Address - Phone:606-638-4332
Practice Address - Fax:606-638-4394
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1048435163W00000X
KY3005329363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
11801850OtherCAQH
000000547906OtherANTHEM BCBS
KY7100146220Medicaid
610661987016OtherTRICARE/HEALTHNET
9973631OtherAETNA
APPROVED 4-27-09OtherLIFESYNCH/HUMANA
P00456562OtherPALMETTO GBA - RR MCR
OH$$$$$$$$$-00OtherBWC - OHIO WORKERS COMPENSATION
610661987016OtherTRICARE/HEALTHNET