Organization
ROCKCASTLE PEDIATRICS & ADOLESCENTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CALLIE SHAFFER M.D. (OWNER)
(606) 256-4148
Entity
Organization
Contact information
Practice address
140 NEWCOMB AVE, MOUNT VERNON, KY 40456-2728
(606) 256-4148
(606) 256-7785
Mailing address
PO BOX 1020, MOUNT VERNON, KY 40456-1020
(606) 256-4148
(606) 256-7785
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
KY
261QR1300X
Rural Health Clinic/Center
Primary
—
KY
363LP0200X
Pediatric Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100081050
—
KY
Enumeration date
07/22/2009
Last updated
02/16/2013
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