Individual
MASON M. SHIVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
405 S L ROGERS WELLS BLVD, GLASGOW, KY 42141-1725
(270) 794-0260
(270) 361-5001
Mailing address
201 PARK ST, BOWLING GREEN, KY 42101-1708
(270) 781-5111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3014190
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100647690
—
KY
Enumeration date
01/27/2020
Last updated
06/23/2022
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