Provider Demographics
NPI:1902894397
Name:SHIELDS, STARLA S (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:STARLA
Middle Name:S
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 S PLUMMER AVE
Mailing Address - Street 2:P. O. BOX 426
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1928
Mailing Address - Country:US
Mailing Address - Phone:620-432-5580
Mailing Address - Fax:620-431-7556
Practice Address - Street 1:1409 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2550
Practice Address - Country:US
Practice Address - Phone:620-432-5580
Practice Address - Fax:620-431-7556
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100316050DMedicaid
KSS58534Medicare UPIN
KS161691Medicare ID - Type Unspecified