Provider Demographics
NPI:1588141931
Name:COULTER, SHELBY BROOKE (APRN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:BROOKE
Last Name:COULTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:BROOKE
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1530 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-7129
Mailing Address - Country:US
Mailing Address - Phone:913-588-9661
Mailing Address - Fax:913-274-3520
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSNONEOtherNO ANSWER