Provider Demographics
NPI:1003662339
Name:SHOEMAKER, KALEB MONROE
Entity type:Individual
Prefix:
First Name:KALEB
Middle Name:MONROE
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S MCKINLEY ST APT C
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5533
Mailing Address - Country:US
Mailing Address - Phone:307-258-8384
Mailing Address - Fax:
Practice Address - Street 1:2200 S MCKINLEY ST APT C
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-5533
Practice Address - Country:US
Practice Address - Phone:307-258-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator