Provider Demographics
NPI:1124563275
Name:SHAW, ALICIA C (FNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:660-263-1225
Mailing Address - Fax:660-263-1613
Practice Address - Street 1:300 N MORLEY ST STE A-C
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2334
Practice Address - Country:US
Practice Address - Phone:660-263-1225
Practice Address - Fax:660-263-1613
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2019-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAA153239363LF0000X
MO2016043696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily