Healthcare Provider Details

I. General information

NPI: 1023990652
Provider Name (Legal Business Name): GUSSIE SHEMWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9600
US

IV. Provider business mailing address

4628 NE 83RD TER
KANSAS CITY MO
64119-7617
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-7200
  • Fax:
Mailing address:
  • Phone: 573-822-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025041351
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: