Healthcare Provider Details

I. General information

NPI: 1881584480
Provider Name (Legal Business Name): INGRID SHORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E RICHMOND ST
SPRINGFIELD MO
65804-7449
US

IV. Provider business mailing address

1607 E RICHMOND ST
SPRINGFIELD MO
65804-7449
US

V. Phone/Fax

Practice location:
  • Phone: 417-353-7103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: