Provider Demographics
NPI:1528449345
Name:STROUD, SHALAN MARIE (APRN)
Entity type:Individual
Prefix:
First Name:SHALAN
Middle Name:MARIE
Last Name:STROUD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHALAN
Other - Middle Name:
Other - Last Name:STAVENAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-3220
Mailing Address - Country:US
Mailing Address - Phone:816-502-7000
Mailing Address - Fax:816-932-7957
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-7940
Practice Address - Fax:816-932-7957
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012022372364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012022372OtherMO LICENSE
KS53-75906-122OtherKANSAS STATE BOARD OF NURSING