Provider Demographics
NPI:1306431135
Name:SHIRAH, KYLEIGH MCILWAIN (FNP-C)
Entity type:Individual
Prefix:
First Name:KYLEIGH
Middle Name:MCILWAIN
Last Name:SHIRAH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KYLEIGH
Other - Middle Name:ALEXIS
Other - Last Name:ODOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:951 MATTHEW DR STE D
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2566
Mailing Address - Country:US
Mailing Address - Phone:601-671-2795
Mailing Address - Fax:601-735-4227
Practice Address - Street 1:951 MATTHEW DR STE D
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2566
Practice Address - Country:US
Practice Address - Phone:601-671-2795
Practice Address - Fax:601-735-4227
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily