Healthcare Provider Details

I. General information

NPI: 1356743835
Provider Name (Legal Business Name): SHELLY R KEESLING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N 14TH AVE STE 104
DODGE CITY KS
67801-2367
US

IV. Provider business mailing address

9300 E 29TH ST N STE 310
WICHITA KS
67226-2160
US

V. Phone/Fax

Practice location:
  • Phone: 620-225-8865
  • Fax: 620-225-8866
Mailing address:
  • Phone: 316-612-1833
  • Fax: 316-612-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01724
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: