Provider Demographics
NPI:1477689172
Name:SHUFFETT, HILARY ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:HILARY
Middle Name:ANN
Last Name:SHUFFETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LIBERTY SQ
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3392
Mailing Address - Country:US
Mailing Address - Phone:606-787-5044
Mailing Address - Fax:606-787-5029
Practice Address - Street 1:112 LIBERTY SQ
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3392
Practice Address - Country:US
Practice Address - Phone:606-787-5044
Practice Address - Fax:606-787-5029
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1017363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant