Provider Demographics
NPI:1982646139
Name:SHELANSKEY, KIMBERLY B (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:B
Last Name:SHELANSKEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:B
Other - Last Name:OBERST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4689
Mailing Address - Country:US
Mailing Address - Phone:815-933-9660
Mailing Address - Fax:815-929-0014
Practice Address - Street 1:200 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4689
Practice Address - Country:US
Practice Address - Phone:815-933-9660
Practice Address - Fax:815-929-0014
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008580363LF0000X
MI4704196003363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKO196003OtherBCBS PIN
ILP01226063OtherRAILROAD MEDICARE
MI4671139Medicaid
MI500D111300OtherBCBS GPOUP
MI500D111300OtherBCBS GPOUP
MIKO196003OtherBCBS PIN