Provider Demographics
NPI:1417934621
Name:HIRST, SHANE M (CNM)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:M
Last Name:HIRST
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-4312
Practice Address - Street 1:635 MAYSVILLE RD # A
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9767
Practice Address - Country:US
Practice Address - Phone:859-498-2323
Practice Address - Fax:859-498-7314
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN09000117A207V00000X
IN28140700A207V00000X
KY3014355367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200524620Medicaid
IN000000377880OtherANTHEM
KY7100659380Medicaid