Provider Demographics
NPI:1558300459
Name:SHAMLEY, KIRK THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:THOMAS
Last Name:SHAMLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E 19TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4946
Mailing Address - Country:US
Mailing Address - Phone:307-637-7886
Mailing Address - Fax:307-637-7925
Practice Address - Street 1:1616 E 19TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4946
Practice Address - Country:US
Practice Address - Phone:307-637-7886
Practice Address - Fax:307-637-7925
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5381A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308311Medicare ID - Type Unspecified
WYF32903Medicare UPIN