Basic Information
| Provider Information | |||||||||
| NPI: | 1225034275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIPMAN | ||||||||
| FirstName: | SHARLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 W 119TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662093724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134914020 | ||||||||
| FaxNumber: | 9134914725 | ||||||||
| Practice Location | |||||||||
| Address1: | 5525 W 119TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662093724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134914020 | ||||||||
| FaxNumber: | 9134914725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 174400000X | 0426992 | KS | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 100315130A | 05 | KS | MEDICAID |