Individual
DR. KENNETH RYAN SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, APRN, FNP-BC
Contact information
Practice address
1405 N TRUMAN BLVD, FESTUS, MO 63028-1177
(636) 933-2243
Mailing address
16607 EVERGREEN FOREST DR, WILDWOOD, MO 63011-1800
(314) 379-4344
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2023036843
MO
Other
Enumeration date
09/08/2023
Last updated
09/08/2023
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