Provider Demographics
NPI:1831424100
Name:HIESBERGER, SHELLEY (NP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:HIESBERGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 NW BLUE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5713
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:816-347-2657
Practice Address - Street 1:760 NW BLUE PARKWAY
Practice Address - Street 2:
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5713
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:816-347-2657
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily