Provider Demographics
NPI:1023432333
Name:MERRITT, SHELLEY M (FNP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:M
Last Name:MERRITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:L
Other - Last Name:CAMBRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:301 E PRICE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:MO
Mailing Address - Zip Code:64485-2482
Mailing Address - Country:US
Mailing Address - Phone:816-432-0006
Mailing Address - Fax:816-432-0008
Practice Address - Street 1:301 E PRICE AVE STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-2482
Practice Address - Country:US
Practice Address - Phone:816-432-0006
Practice Address - Fax:816-432-0008
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014003307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1023432333Medicaid
MO1023432333Medicaid