Provider Demographics
NPI:1952659427
Name:GINGERICH, SHELLY R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:R
Last Name:GINGERICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:R
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:53 US HIGHWAY 60-63
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-3463
Mailing Address - Country:US
Mailing Address - Phone:573-201-1035
Mailing Address - Fax:
Practice Address - Street 1:1137 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4221
Practice Address - Country:US
Practice Address - Phone:417-255-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012019339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily