MEDICARE: SHAYLA NICOLE MULLIGAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.1001304-NP	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53-82337-112	KS

General Provider Information

NPI Number	:	1538847082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA NICOLE MULLIGAN APRN

Provider Business Mailing Address
First Line	:	500 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-3304
Country	:	US
Telephone Number	:	620-604-5274
Fax Number	:	855-538-3350

Provider Business Practice Location Address
First Line	:	2120 BLAKE ST APT 428
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3080
Country	:	US
Telephone Number	:	720-335-5768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	02/17/2026

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