Provider Demographics
NPI:1194996892
Name:WATTS, SHELLEY A (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:WATTS
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13725 METCALF AVE # 403
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-7899
Mailing Address - Country:US
Mailing Address - Phone:913-498-8787
Mailing Address - Fax:913-498-1744
Practice Address - Street 1:5721 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-498-8787
Practice Address - Fax:913-498-1744
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74929-072363L00000X
MO2000163262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200549940BMedicaid
KS53-74929-072OtherKANSAS LICENSE