Basic Information
| Provider Information | |||||||||
| NPI: | 1942736517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHADOAN | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1080 | ||||||||
| Address2: | |||||||||
| City: | BURKESVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427171080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708586644 | ||||||||
| FaxNumber: | 2708584027 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 MEDICAL LOOP STE 3 | ||||||||
| Address2: | |||||||||
| City: | WHITLEY CITY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 426534382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063765391 | ||||||||
| FaxNumber: | 8889602041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2017 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TP338 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 60197 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 55801 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.