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Individual

SHANE ALLAN PHILLIBER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CNP

Contact information

Practice address
530 S MAIDEN LN, JOPLIN, MO 64801-3084
(417) 782-6200
(417) 782-3084
Mailing address
14741 TULSA LN, STARK CITY, MO 64866-7964
(417) 638-5183

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2021049273
MO
363LF0000X
Family Nurse Practitioner
2021049273
MO

Other

Enumeration date
12/21/2021
Last updated
12/19/2024
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