Provider Demographics
NPI:1417308362
Name:SHANDS, MELISSA M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:SHANDS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17921 BCR 262
Mailing Address - Street 2:
Mailing Address - City:SEDGEWICKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63781-3023
Mailing Address - Country:US
Mailing Address - Phone:573-301-3435
Mailing Address - Fax:
Practice Address - Street 1:1508 EDGEMONT BLVD
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1231
Practice Address - Country:US
Practice Address - Phone:573-768-3220
Practice Address - Fax:573-768-3221
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily