| Doctor Name: | SHANE TRAVIS KISER |
| NPI Number: | 1003286709 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | TC427 |
| Business Practice Address: | 10650 Us Route 60 Ashland, KY - 411029611 |
| Business Phone Number: | 6064086301 |
| Business Fax Number: | 6064086350 |
| Mailing Address: | Po Box 1595, ASHLAND |
| State: | KY |
| Postal Code: | 411051595 |
| Phone Number: | 6064086200 |
| Fax Number: | 6064086612 |
| NPI Enumeration Date: | 10/07/2015 |
| NPI Last Update Date: | 10/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | TC427 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |