Basic Information
Provider Information
NPI: 1659535219
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: USERY
FirstName: SHAWN
MiddleName: NEWTON
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 802843
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641802843
CountryCode: US
TelephoneNumber: 4177306430
FaxNumber: 4172697567
Practice Location
Address1: 3801 S NATIONAL AVE STE 1122
Address2:  
City: SPRINGFIELD
State: MO
PostalCode: 658076090
CountryCode: US
TelephoneNumber: 4172697728
FaxNumber: 4172697729
Other Information
ProviderEnumerationDate: 07/14/2008
LastUpdateDate: 11/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X2009020195MOY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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