Shuck, Kellie L

Shuck, Kellie L is an individual health care provider with primary practice located at 30 Houlton St , Patten ME 04765-3035. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Shuck, Kellie L can be contacted via phone (866) 366-5842.

Contact Information

Primary practice address
30 Houlton St Patten ME 04765-3035
Phone: (866) 366-5842
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 364SP0808X 2000161947 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X CNP211623 Maine

Profile Details

NPI number 1598720534
LBN Legal business name Shuck, Kellie L
Credentials PMHNP-CNS, BC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 20th, 2006
Last updated Feb 10th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598720534 NPPES
Missouri MEDICAID 427531801

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