Provider Demographics
NPI:1083828206
Name:AUSTIN, MASHONNA L (MD)
Entity type:Individual
Prefix:
First Name:MASHONNA
Middle Name:L
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:604 JAMES TRIMBLE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1026
Mailing Address - Country:US
Mailing Address - Phone:606-789-3072
Mailing Address - Fax:606-789-1860
Practice Address - Street 1:604 JAMES TRIMBLE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1026
Practice Address - Country:US
Practice Address - Phone:606-789-3072
Practice Address - Fax:606-789-1860
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46800208600000X
KYTP569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery