Provider Demographics
NPI:1225095060
Name:DUKE, SHELLY M (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:M
Last Name:DUKE
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:M
Other - Last Name:KILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:913-945-2080
Mailing Address - Fax:913-945-2095
Practice Address - Street 1:21 CORPORATE WOODS, 10870 BENSON DRIVE #2160
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:833-357-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139284163W00000X, 363L00000X
KS14-72612-121163W00000X
KS45319363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200364830AMedicaid
36825013OtherBCBS
MO427616909Medicaid
KS200364830AMedicaid
I49221Medicare UPIN
MO427616909Medicaid