Provider Demographics
NPI:1649240979
Name:SHIELDS, THOMAS BERNARD (ARNP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BERNARD
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 BROOKHAVEN RD
Mailing Address - Street 2:PO BOX 346
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42135-0346
Mailing Address - Country:US
Mailing Address - Phone:270-586-1800
Mailing Address - Fax:
Practice Address - Street 1:1030 BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2745
Practice Address - Country:US
Practice Address - Phone:270-586-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA093798363LF0000X
KY6167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6450320Medicaid
IAI14023Medicare ID - Type Unspecified
IAQ20916Medicare UPIN