Individual
KEVIN D SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
122 COLUMBUS RD, FREDERICKTOWN, OH 43019-1266
(740) 694-1261
(740) 694-7145
Mailing address
122 COLUMBUS RD, FREDERICKTOWN, OH 43019-1266
(740) 694-1261
(740) 694-7145
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004569RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01588381
—
OH
Enumeration date
01/26/2016
Last updated
02/28/2023
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