Provider Demographics
NPI:1497282974
Name:WAUGH, SHAWN MICHELLE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MICHELLE
Last Name:WAUGH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E REED ST REAR
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-1242
Mailing Address - Country:US
Mailing Address - Phone:573-359-3230
Mailing Address - Fax:573-359-3240
Practice Address - Street 1:907 E REED ST REAR
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1242
Practice Address - Country:US
Practice Address - Phone:573-359-3230
Practice Address - Fax:573-359-3240
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017005140363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner