Kristen Lynn Shores, CCC-MA

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2009024735 Issued in MO

Practice address

4650 McMasters Ave
Hannibal, MO 63401-2244

Phone

(573) 221-1258

Fax

(573) 221-2994

NPI assigned

Sep 16, 2009

Last updated

Jan 22, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hannibal School District #60

  • Local Education Agency (LEA)
  • Hannibal, MO
  • NPI 1821143082
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1457684854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 MCMASTERS AVE",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634012244",
            "telephone_number": "573-221-1258",
            "fax_number": "573-221-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 MCMASTERS AVE",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634012244",
            "telephone_number": "573-221-1258",
            "fax_number": "573-221-2994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORES",
        "first_name": "KRISTEN",
        "middle_name": "LYNN",
        "credential": "CCC-MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-16",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2009024735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn M Shima, APN
• Shinn Residential Center, Inc.
• Shinn Residential Center, Inc.
• Shinn Residential Center, Inc.
• Amelia Shipman
• Mujeeb U Siddiqui, DO
• Jamie Leigh Silvey, RN
• Nathan William Simmons, CRNA
• Kara Lynn Sinclair, RN
• Bishakha Singh, DMD

• Speech-Language Pathologist in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.