Provider Demographics
NPI:1619012937
Name:METKER, SHIRLEY DAWN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:DAWN
Last Name:METKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KIDSFORT TRAIL
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484
Mailing Address - Country:US
Mailing Address - Phone:606-365-3102
Mailing Address - Fax:
Practice Address - Street 1:44 HEALTH WAY
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484
Practice Address - Country:US
Practice Address - Phone:606-365-3106
Practice Address - Fax:606-365-1640
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1071665163W00000X
KY2064P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse