MEDICARE: SHELLEY LYNN GIBB RDN

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	133V00000X	Registered Dietitian	2001018096	MO
2	133V00000X	Registered Dietitian	516	KS

General Provider Information

NPI Number	:	1720882335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY LYNN GIBB RDN

Provider Business Mailing Address
First Line	:	9235 N BELTON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-7816
Country	:	US
Telephone Number	:	816-500-6851
Fax Number	:

Provider Business Practice Location Address
First Line	:	9235 N BELTON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-7816
Country	:	US
Telephone Number	:	816-500-6851
Fax Number	:

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

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	04/02/2025

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