Provider Demographics
NPI:1285794040
Name:SHIDLER, KELLI J (MD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:J
Last Name:SHIDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLI
Other - Middle Name:J
Other - Last Name:PAULING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:6715 S 180TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1883
Practice Address - Country:US
Practice Address - Phone:402-996-2300
Practice Address - Fax:531-355-0001
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE251093OtherMIDLANDS CHOICE
NE01516OtherBCBS OF NEBRASKA