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Individual
SHAVON PRENTICE
Active
Individual
SHAVON PRENTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
71003614A
IN
363LF0000X
Family Nurse Practitioner
Primary
3007023
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100200290
—
KY
Enumeration date
08/19/2011
Last updated
12/19/2022
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