Provider Demographics
NPI:1821701350
Name:SHOOK, KELSIE ELAINE
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:ELAINE
Last Name:SHOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 LURA DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1534
Mailing Address - Country:US
Mailing Address - Phone:417-839-8398
Mailing Address - Fax:
Practice Address - Street 1:307 LURA DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-1534
Practice Address - Country:US
Practice Address - Phone:417-839-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider