Provider Demographics
NPI:1801697123
Name:KAUFFMAN, SHANNON ELYSE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELYSE
Last Name:KAUFFMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7723 NW EASTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1738
Mailing Address - Country:US
Mailing Address - Phone:816-489-9501
Mailing Address - Fax:
Practice Address - Street 1:7723 NW EASTSIDE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-1738
Practice Address - Country:US
Practice Address - Phone:816-489-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant