Provider Demographics
NPI:1417453069
Name:NAFSU, SHIVAUN
Entity Type:Individual
Prefix:
First Name:SHIVAUN
Middle Name:
Last Name:NAFSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BRULE ST
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-6100
Mailing Address - Country:US
Mailing Address - Phone:502-626-9891
Mailing Address - Fax:
Practice Address - Street 1:200 BRULE ST
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-6100
Practice Address - Country:US
Practice Address - Phone:502-626-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2552721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical