Healthcare Provider Details

I. General information

NPI: 1871119727
Provider Name (Legal Business Name): KELLY DAWN TRICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY DAWN SHRINER APRN, FNP

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E HELEN ST
HERINGTON KS
67449-1606
US

IV. Provider business mailing address

PO BOX 1386
JUNCTION CITY KS
66441-1386
US

V. Phone/Fax

Practice location:
  • Phone: 785-258-2207
  • Fax: 785-258-3535
Mailing address:
  • Phone: 785-258-2207
  • Fax: 785-258-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number96033
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78991-051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: