Provider Demographics
NPI:1639839822
Name:FOLEY, SHANNA MICHELLE (PNP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MICHELLE
Last Name:FOLEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 E 157TH ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-3500
Mailing Address - Country:US
Mailing Address - Phone:816-682-0838
Mailing Address - Fax:
Practice Address - Street 1:3801 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2807
Practice Address - Country:US
Practice Address - Phone:816-682-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021047827363LP0200X
KS53-80768-031363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics