Provider Demographics
NPI:1720882335
Name:GIBB, SHELLEY LYNN (RDN)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:GIBB
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:LYNN
Other - Last Name:MUNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9235 N BELTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-7816
Mailing Address - Country:US
Mailing Address - Phone:816-500-6851
Mailing Address - Fax:
Practice Address - Street 1:9235 N BELTON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-7816
Practice Address - Country:US
Practice Address - Phone:816-500-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018096133V00000X
KS516133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered