Provider Demographics
NPI:1689614166
Name:SHEARER, JACQUELINE L (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:SHEARER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NW SAINT MARY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2524
Mailing Address - Country:US
Mailing Address - Phone:816-228-1000
Mailing Address - Fax:816-463-6035
Practice Address - Street 1:801 NW SAINT MARY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2524
Practice Address - Country:US
Practice Address - Phone:816-228-1000
Practice Address - Fax:816-463-6035
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO084894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26960Medicare UPIN
J61A925Medicare ID - Type Unspecified
P26960Medicare UPIN
500023498OtherRR MEDICARE