Healthcare Provider Details

I. General information

NPI: 1447009014
Provider Name (Legal Business Name): KATHRYN A SHINKLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE A SHINKLE

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17611 E US HIGHWAY 24
INDEPENDENCE MO
64056-1853
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 816-836-6350
  • Fax:
Mailing address:
  • Phone: 417-761-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13402
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024023432
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: