Provider Demographics
NPI:1548335151
Name:SHANE-CARSON, KATE PARKS (MS, LGC)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:PARKS
Last Name:SHANE-CARSON
Suffix:
Gender:F
Credentials:MS, LGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 POLARIS PARKWAY
Mailing Address - Street 2:OHIO STATE UNIVERSITY CLINICAL CANCER GENETICS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240
Mailing Address - Country:US
Mailing Address - Phone:614-293-6694
Mailing Address - Fax:614-293-2314
Practice Address - Street 1:2001 POLARIS PARKWAY
Practice Address - Street 2:OHIO STATE UNIVERSITY CLINICAL CANCER GENETICS
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240
Practice Address - Country:US
Practice Address - Phone:614-293-6694
Practice Address - Fax:614-293-2314
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS