Healthcare Provider Details

I. General information

NPI: 1285794040
Provider Name (Legal Business Name): KELLI J SHIDLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI J PAULING M.D.

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17675 WELCH PLZ
OMAHA NE
68135-3551
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-7630
  • Fax: 402-354-7635
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23204
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: