Provider Demographics
NPI:1285142380
Name:HARPER, SHELLEY RENE
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENE
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-0216
Mailing Address - Country:US
Mailing Address - Phone:307-575-1827
Mailing Address - Fax:
Practice Address - Street 1:2205 CR 4300
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-5700
Practice Address - Country:US
Practice Address - Phone:307-575-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator