Healthcare Provider Details

I. General information

NPI: 1871433193
Provider Name (Legal Business Name): SHAKYA WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 BALTIMORE AVE
KANSAS CITY MO
64111-2303
US

IV. Provider business mailing address

1409 FOX RUN TRL
PLATTE CITY MO
64079-7643
US

V. Phone/Fax

Practice location:
  • Phone: 913-346-4768
  • Fax:
Mailing address:
  • Phone: 816-665-9315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: