DR. TREVECCA KERRY SHAW DPM NPI 1497917165

NPI Information

NPI: 1497917165
Provider Name: DR. TREVECCA KERRY SHAW, DPM
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

PECOS Registration: Yes

Address:
2406 W BROADWAY
LOUISVILLE, KY
ZIP 40211
Phone: (502) 775-1711
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DR. Trevecca Kerry Shaw, DPM is a foot and ankle surgery podiatrist in Louisville, KY. DR. Trevecca Kerry Shaw, DPM NPI is 1497917165. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2406 W BROADWAY
LOUISVILLE, KY
ZIP 40211-008
Phone: (502) 775-1711
Fax: (502) 443-0369

The NPI 1497917165 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/25/2008 and was last updated on 3/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	00338	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2919864	MEDICAID	OHIO
2	000000614278	OTHER		ANTHEM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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