MEDICARE: SHIPLEY NEURO PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528785342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIPLEY NEURO PEDIATRICS

Provider Business Mailing Address
First Line	:	2593 US HIGHWAY 2 E
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-9507
Country	:	US
Telephone Number	:	406-318-6306
Fax Number	:	406-313-9354

Provider Business Practice Location Address
First Line	:	2593 US HIGHWAY 2 E
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-9507
Country	:	US
Telephone Number	:	406-318-6306
Fax Number	:	406-313-9354

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MS. JENNIFER LAURA SHIPLEY
Credential	:	CPNP
Telephone Number	:	406-318-6306

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	01/13/2026

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Directions to “SHIPLEY NEURO PEDIATRICS ” Practice Location

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