# ELITE PROFESSIONAL PROVIDERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891488433
- **Authorized official:** SHAWN KELLEY (COO)
- **Authorized official phone:** (417) 220-4482

## Contact information

- **Practice address:** 3322 S CAMPBELL AVE STE T-1, SPRINGFIELD, MO 65807-4980
- **Practice address phone:** (417) 220-4482
- **Practice address fax:** (417) 414-0017
- **Mailing address:** 2135 E INDEPENDENCE ST \# 1093, SPRINGFIELD, MO 65804-3749
- **Mailing address phone:** (417) 220-4482
- **Mailing address fax:** (417) 414-0017

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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