Healthcare Provider Details

I. General information

NPI: 1225872914
Provider Name (Legal Business Name): SHELBIE KATELYNN ROSE GRAHAM DNP-ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

IV. Provider business mailing address

16243 GENEVA RD
WATSON MO
64496-8425
US

V. Phone/Fax

Practice location:
  • Phone: 660-686-2211
  • Fax:
Mailing address:
  • Phone: 660-253-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025018924
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2020042209
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA184703
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: