Provider Demographics
NPI:1972550481
Name:SHIREY, NANCY R (CNM, APRN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:SHIREY
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 SUMMIT SQUARE PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2636
Mailing Address - Country:US
Mailing Address - Phone:859-381-1066
Mailing Address - Fax:859-263-0650
Practice Address - Street 1:3213 SUMMIT SQUARE PL
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2636
Practice Address - Country:US
Practice Address - Phone:859-381-1066
Practice Address - Fax:859-263-0650
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003740363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100053490OtherMEDICAID NP GROUP
KY78008372Medicaid
KY000000310590OtherANTHEM
KY7100053490OtherMEDICAID NP GROUP
KYP63110Medicare UPIN
KY7831Medicare PIN