Individual
SHASTA WEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
907 N MULBERRY ST STE 200, ELIZABETHTOWN, KY 42701-2018
(270) 982-7372
(270) 982-7372
Mailing address
2810 FRONTIER CT APT 1, RADCLIFF, KY 40160-9075
(502) 353-8277
(270) 982-7372
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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