Provider Demographics
NPI:1407630395
Name:SHIELDS, MARCIE M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:M
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:M
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9995 COUNTY LANE 110
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-5478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 MCINTOSH CIR STE 2
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3690
Practice Address - Country:US
Practice Address - Phone:417-347-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013035981163W00000X
MO2023034366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse