Provider Demographics
NPI:1801381876
Name:LEPPIN, SHELBY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:LEPPIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0034
Mailing Address - Country:US
Mailing Address - Phone:660-626-0640
Mailing Address - Fax:
Practice Address - Street 1:900 E LAHARPE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4520
Practice Address - Country:US
Practice Address - Phone:660-292-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018021492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health