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General NPI Number Information
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NPI Number | 1619777661
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Entity Type | Individual
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Provider Name | SHANNON LORRAINE KELLY APRN, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 3801 DR MARTIN LUTHER KING JR BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64130-2807
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Country | US
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Telephone | 816-923-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 5122 HARDY ST
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City | OVERLAND PARK
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State | KS
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Zip | 66202-1138
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Country | US
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Telephone | 913-233-6677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2025007035
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License Number State | MO
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