Healthcare Provider Details

I. General information

NPI: 1285560763
Provider Name (Legal Business Name): SHANICKA MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 E 65TH ST
KANSAS CITY MO
64131-1202
US

IV. Provider business mailing address

1165 E 65TH ST
KANSAS CITY MO
64131-1202
US

V. Phone/Fax

Practice location:
  • Phone: 816-469-0194
  • Fax:
Mailing address:
  • Phone: 816-469-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026015922
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: