Provider Demographics
NPI:1548389505
Name:GURLEY, SHELLEY KATHLEEN (NP)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:KATHLEEN
Last Name:GURLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:KATHLEEN
Other - Last Name:FAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:20805 W 151 SUITE 400
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-780-4900
Mailing Address - Fax:913-780-0949
Practice Address - Street 1:20805 W 151ST ST # 400
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7249
Practice Address - Country:US
Practice Address - Phone:913-780-4900
Practice Address - Fax:913-780-0949
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75160363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201133990BMedicaid
KS391C00034OtherMEDICARE WPS
MO32506016OtherBCBS-KC
MO32506016OtherBCBS-KC
MOMA2231020Medicare PIN
MOB75C284Medicare ID - Type Unspecified