Provider Demographics
NPI:1225872914
Name:GRAHAM, SHELBIE KATELYNN ROSE (DNP-ARNP)
Entity type:Individual
Prefix:
First Name:SHELBIE
Middle Name:KATELYNN ROSE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DNP-ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16243 GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:MO
Mailing Address - Zip Code:64496-8425
Mailing Address - Country:US
Mailing Address - Phone:660-253-0004
Mailing Address - Fax:
Practice Address - Street 1:1219 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:IA
Practice Address - Zip Code:51640-1375
Practice Address - Country:US
Practice Address - Phone:712-382-2626
Practice Address - Fax:712-382-2626
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042209163W00000X
MO2025018924363LF0000X
IAA184703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse