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Organization
ELITE PROFESSIONAL PROVIDERS, LLC
Active
Organization
ELITE PROFESSIONAL PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN KELLEY (COO)
(417) 220-4482
Entity
Organization
Contact information
Practice address
3322 S CAMPBELL AVE STE T-1, SPRINGFIELD, MO 65807-4980
(417) 220-4482
(417) 414-0017
Mailing address
2135 E INDEPENDENCE ST # 1093, SPRINGFIELD, MO 65804-3749
(417) 220-4482
(417) 414-0017
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/30/2023
Last updated
07/07/2026
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