Provider Demographics
NPI:1972345957
Name:SHIRK, MERCY GRACE (LCPM)
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:GRACE
Last Name:SHIRK
Suffix:
Gender:F
Credentials:LCPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7364 HIGHWAY 910
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-9702
Mailing Address - Country:US
Mailing Address - Phone:502-382-7162
Mailing Address - Fax:
Practice Address - Street 1:7364 HIGHWAY 910
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-9702
Practice Address - Country:US
Practice Address - Phone:502-382-7162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4023113176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife