Provider Demographics
NPI:1144698846
Name:SWAFFORD, SHELLEY R (BSN, MSN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:R
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:BSN, MSN, NP-C
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:SLAHCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:19600 E 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2301
Mailing Address - Country:US
Mailing Address - Phone:816-698-7170
Mailing Address - Fax:
Practice Address - Street 1:19600 E 39TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2301
Practice Address - Country:US
Practice Address - Phone:816-698-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022451163WE0003X
MO2015039023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency