Provider Demographics
NPI:1891016358
Name:LYNCH, SHELLY M (NP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:M
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1200 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1420
Mailing Address - Country:US
Mailing Address - Phone:660-584-7751
Mailing Address - Fax:660-584-8261
Practice Address - Street 1:513 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3103
Practice Address - Country:US
Practice Address - Phone:660-747-7751
Practice Address - Fax:660-747-8398
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1499522042363L00000X
MO2010011279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner