Healthcare Provider Details

I. General information

NPI: 1255901898
Provider Name (Legal Business Name): SHANON K LUKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W CLAY RD
VERSAILLES MO
65084-1177
US

IV. Provider business mailing address

305 W MAIN ST
SEDALIA MO
65301-3821
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-2351
  • Fax: 866-208-0157
Mailing address:
  • Phone: 660-826-4774
  • Fax: 866-208-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021020969
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: