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MCKENNA IVY SHOFROTH RN
NPI 1962158501
Registered Nurse - General Practice in Maryville, IL

Active since February 22, 2022
20 PROFESSIONAL PARK DR STE B, MARYVILLE, IL 62062(618) 288-1480(888) 718-4696 Get Directions Write a Review

NPPES record last updated: February 22, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mckenna Ivy Shofroth Rn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MCKENNA IVY SHOFROTH RN (NPI 1962158501) is an individual general practice provider in Maryville, Illinois, licensed in Illinois (041521566) and active in the NPI registry since February 2022.

NPPES Registry Identity

NPI1962158501
Entity TypeIndividualFemale
Primary Taxonomy163WG0000X
Provider Legal NameMCKENNA IVY SHOFROTHCredential: RN
Location Address20 PROFESSIONAL PARK DR STE BMaryville, IL 62062-5830
Mailing Address20 Professional Park Dr Ste BMaryville, IL 62062-5830 · (618) 288-1480 · Fax (888) 718-4696
Phone(618) 288-1480
Fax(888) 718-4696
Sole ProprietorNo
Enumeration DateFebruary 22, 2022
NPPES CertifiedFebruary 18, 2022
✔ NPI 1962158501 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRegistered Nurse · General PracticeNursing Service Providers
Taxonomy Code163WG0000X
License✔ Licensed in IL · 041521566
20 PROFESSIONAL PARK DR STE B, Maryville, IL 62062
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Other Identifiers 1

Medicaid1417916099IL

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PATRESE P SCHNEIDER
Nurse Practitioner (Family)
20 PROFESSIONAL PARK DR STE B
MARYVILLE, IL 62062
Madison County (618) 288-1480
MRS. JAMIE MICHELLE SCHNEIDER FNP
Nurse Practitioner (Family)
20 PROFESSIONAL PARK DR STE B
MARYVILLE, IL 62062
Madison County (618) 288-1480
KAYLA B WUEBBELS FNP
Nurse Practitioner (Family)
20 PROFESSIONAL PARK DR STE B
MARYVILLE, IL 62062
Madison County (618) 288-1480
ABBY MARIE BEEDY PA-C
Physician Assistant (Medical)
20 PROFESSIONAL PARK DR STE B
MARYVILLE, IL 62062
Madison County (618) 288-1480

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mckenna Shofroth's NPI number?

The NPI number for Mckenna Shofroth is 1962158501. It was assigned to this individual provider in the NPPES registry on February 22, 2022.

Where is Mckenna Shofroth located?

Mckenna Shofroth practices at 20 Professional Park Dr Ste B, Maryville, IL 62062. The listed phone number is (618) 288-1480.

What is Mckenna Shofroth's specialty?

The primary specialty registered for this NPI is Registered Nurse, specializing in General Practice, with taxonomy code 163WG0000X.

When was this NPI record last updated?

The NPPES record for Mckenna Shofroth was last updated on February 22, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.