Basic Information
| Provider Information | |||||||||
| NPI: | 1417934621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIRST | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 236 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594047686 | ||||||||
| FaxNumber: | 8592744312 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 MAYSVILLE RD # A | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403539767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594982323 | ||||||||
| FaxNumber: | 8594987314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 09000117A | IN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 28140700A | IN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 367A00000X | 3014355 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 200524620 | 05 | IN | MEDICAID | 000000377880 | 01 | IN | ANTHEM | OTHER | 7100659380 | 05 | KY | MEDICAID |