Shelly C. Crader, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

53-77054 Issued in KS

Practice address

2318 E Central Ave
Wichita, KS 67214-4436

Phone

(316) 262-3611

Fax

(316) 262-0318

NPI assigned

Dec 29, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Shelly C. Dark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1451347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451347200000",
    "number": "1790140150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2318 E CENTRAL AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672144436",
            "telephone_number": "316-262-3611",
            "fax_number": "316-262-0318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2318 E CENTRAL AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672144436",
            "telephone_number": "316-262-3611",
            "fax_number": "316-262-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRADER",
        "first_name": "SHELLY",
        "middle_name": "C.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-29",
        "last_updated": "2015-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KS",
            "license": "53-77054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "DARK",
            "middle_name": "C.",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nurse Practitioner in Wichita, KS
• Providers in Wichita, KS by specialty
• Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; 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.