Provider Demographics
NPI:1679152276
Name:ZIRKLE, SHAUMBER
Entity type:Individual
Prefix:
First Name:SHAUMBER
Middle Name:
Last Name:ZIRKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHUAMBER
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1134 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-2600
Mailing Address - Country:US
Mailing Address - Phone:740-446-9129
Mailing Address - Fax:
Practice Address - Street 1:1134 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-2600
Practice Address - Country:US
Practice Address - Phone:740-446-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0191991Medicaid