Individual
SHAWNEE LYNN KELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNBCFNP
Contact information
Practice address
700 W JEFFERSON ST, KIRKSVILLE, MO 63501-1441
(660) 626-2191
(660) 626-2396
Mailing address
700 W JEFFERSON ST, PO BOX 7545, KIRKSVILLE, MO 63501-1441
(660) 626-2191
(660) 626-2396
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
113721
MO
363LF0000X
Family Nurse Practitioner
Primary
113721
MO
363LF0000X
Family Nurse Practitioner
A153236
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014853
MEDICARE GROUP #
—
05
—
428713812
—
MO
01
—
501218200
MEDICAID GROUP #
MO
01
—
DG4290
RAILROAD MEDICARE GROUP #
MO
01
—
P00435145
RAILROAD MEDICARE PTAN
MO
Enumeration date
11/21/2005
Last updated
02/02/2026
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