Provider Demographics
NPI:1740735885
Name:SHOTWELL, KENYA SHANTA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KENYA
Middle Name:SHANTA
Last Name:SHOTWELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 DUNN RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1755
Mailing Address - Country:US
Mailing Address - Phone:636-266-7946
Mailing Address - Fax:314-364-6381
Practice Address - Street 1:637 DUNN RD STE 102A
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1755
Practice Address - Country:US
Practice Address - Phone:636-266-7946
Practice Address - Fax:314-364-6381
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016000991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily