Individual
CALLIE E SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
140 NEWCOMB AVE, MOUNT VERNON, KY 40456-2728
(606) 256-4148
(606) 256-7785
Mailing address
PO BOX 1525, MOUNT VERNON, KY 40456-1525
(606) 256-4148
(606) 256-5191
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38737
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000337528
ANTHEM BC/BS
KY
01
—
000000475691
DEPT OF LABOR
KY
01
—
1217376
CHA
KY
01
—
27-0496454
TAX ID (EFFECT. 01/01/10)
KY
01
—
38737
MEDICAL LICENSE NUMBER
KY
01
—
637591
ANTHEM PIN (EFFECT. 01/01/10)
KY
05
—
64087299
—
KY
05
—
7100081050
—
KY
Enumeration date
08/22/2006
Last updated
03/07/2023
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