Provider Demographics
NPI:1285792739
Name:ISAACS, SHAWN C (APRN-NA)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:C
Last Name:ISAACS
Suffix:
Gender:M
Credentials:APRN-NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-587-4799
Mailing Address - Fax:502-540-3730
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-587-4799
Practice Address - Fax:502-540-3730
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3289A367500000X
KY3003289367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1125439Medicaid
KY74002403Medicaid
KY000000286891OtherANTHEM
IN200311970AMedicaid
KY000000286891Medicare ID - Type UnspecifiedANTHEM SENIOR
KY000000286891OtherANTHEM
KY74002403Medicaid
IN200311970AMedicaid
KYK036090Medicare PIN