Provider Demographics
NPI:1316991888
Name:SHIRLEY, VICTORIA A (DO)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MT CARMEL WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-7587
Mailing Address - Country:US
Mailing Address - Phone:620-230-0044
Mailing Address - Fax:
Practice Address - Street 1:1300 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6650
Practice Address - Country:US
Practice Address - Phone:620-230-0044
Practice Address - Fax:620-230-0543
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050921207V00000X
IN02004400A207V00000X
KS05-47651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201225010Medicaid
IN874997OtherANTHEM
IN7293368OtherAETNA
KY7100306460Medicaid
IN412840033Medicare PIN
H65644Medicare UPIN
GA151450027Medicaid