Provider Demographics
NPI:1871119727
Name:TRICKEY, KELLY DAWN
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DAWN
Last Name:TRICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DAWN
Other - Last Name:SHRINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-1386
Mailing Address - Country:US
Mailing Address - Phone:785-258-2207
Mailing Address - Fax:785-258-3535
Practice Address - Street 1:100 E HELEN ST
Practice Address - Street 2:
Practice Address - City:HERINGTON
Practice Address - State:KS
Practice Address - Zip Code:67449-1606
Practice Address - Country:US
Practice Address - Phone:785-258-2207
Practice Address - Fax:785-258-3535
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS96033163W00000X
KS53-78991-051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse