Healthcare Provider Details

I. General information

NPI: 1851999437
Provider Name (Legal Business Name): SHELLY ANN SORDEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E HOSPITAL RD
EL DORADO SPRINGS MO
64744-2024
US

IV. Provider business mailing address

400 E HOSPITAL RD
EL DORADO SPRINGS MO
64744-2024
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-2531
  • Fax: 417-876-3459
Mailing address:
  • Phone: 417-876-2531
  • Fax: 417-876-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020034600
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: