Individual
DEVON MICHELLE SHAUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 FREDERICA ST, OWENSBORO, KY 42301-4230
(651) 270-3801
Mailing address
3000 FREDERICA ST, ATHLETIC TRAINING ROOM, OWENSBORO, KY 42301
(651) 270-3801
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
2000039774
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000039774
BOARD OF CERTIFICATION
KY
Enumeration date
09/09/2020
Last updated
09/09/2020
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