Provider Demographics
NPI:1699472068
Name:HOUSE, SHELLY ANN (MSN, FNP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:HOUSE
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:ANN
Other - Last Name:LEFFINGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:7590 N EVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4685
Mailing Address - Country:US
Mailing Address - Phone:573-280-4905
Mailing Address - Fax:
Practice Address - Street 1:18640 E 38TH TER S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2304
Practice Address - Country:US
Practice Address - Phone:816-229-1191
Practice Address - Fax:816-229-1198
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023001571207QA0505X
KS5381916012207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine