Healthcare Provider Details

I. General information

NPI: 1144698846
Provider Name (Legal Business Name): SHELLEY R SWAFFORD BSN, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY SLAHCK BSN

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

IV. Provider business mailing address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

V. Phone/Fax

Practice location:
  • Phone: 816-698-7170
  • Fax:
Mailing address:
  • Phone: 816-698-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2006022451
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015039023
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: