Provider Demographics
NPI:1437705001
Name:O'CONNELL, MICHELLE GAIL (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GAIL
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22361 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHELL KNOB
Mailing Address - State:MO
Mailing Address - Zip Code:65747-7822
Mailing Address - Country:US
Mailing Address - Phone:417-858-3731
Mailing Address - Fax:
Practice Address - Street 1:22361 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:SHELL KNOB
Practice Address - State:MO
Practice Address - Zip Code:65747-7822
Practice Address - Country:US
Practice Address - Phone:417-858-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019026407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily