Healthcare Provider Details

I. General information

NPI: 1194544726
Provider Name (Legal Business Name): SHELLY LYNN HULSEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 S LINDBERGH BLVD STE 210
SAINT LOUIS MO
63127-1387
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-0420
  • Fax: 384-421-0631
Mailing address:
  • Phone: 314-525-0420
  • Fax: 314-996-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2025018391
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2014022750
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: