Shelby Lynn Icenhower, NP-C
Nurse Practitioner, Family in Springfield, MO. Individual provider (NPI-1).
NPI number1619645918
StatusActive
Last updated in NPPESSep 1, 2021
Details
- NPI
- 1619645918
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Shelby Lynn Icenhower
- Credential
- NP-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 1, 2021
- Certification date
- Sep 1, 2021
- Last updated
- Sep 1, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 2021031470 | MO | Yes |
Practice location
1235 E Cherokee StSpringfield, MO 65804-2203
Phone 417-820-2115
Mailing address
1235 E Cherokee StSpringfield, MO 65804-2203
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