MEDICARE: SHELBY DIANE RUDDELL

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	163W00000X	Registered Nurse	2019023072	MO
2	163WL0100X	Lactation Consultant (Registered Nurse)	L-320792	MO

General Provider Information

NPI Number	:	1831057819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY DIANE RUDDELL

Provider Business Mailing Address
First Line	:	656 SE BAYBERRY LN
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-4301
Country	:	US
Telephone Number	:	816-281-7558
Fax Number	:

Provider Business Practice Location Address
First Line	:	656 SE BAYBERRY LN
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-4301
Country	:	US
Telephone Number	:	816-281-7558
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ SHELBY DIANE RUDDELL ” Practice Location

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