1225095060 NPI number — MRS. SHELLY M DUKE RN, FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225095060 NPI number — MRS. SHELLY M DUKE RN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUKE
Provider First Name:
SHELLY
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KILLMAN
Provider Other First Name:
SHELLY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225095060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 RESEARCH PARK DR
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-4873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-945-2080
Provider Business Mailing Address Fax Number:
913-945-2095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 CORPORATE WOODS, 10870 BENSON DRIVE #2160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-357-3227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  139284 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 14-72612-121 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 139284 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 45319 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200364830A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36825013 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 427616909 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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