Provider Demographics
NPI:1639840051
Name:BAIRD, SHELLIE DIANE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLIE
Middle Name:DIANE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 W AMBER DR
Mailing Address - Street 2:
Mailing Address - City:ORONOGO
Mailing Address - State:MO
Mailing Address - Zip Code:64855-8240
Mailing Address - Country:US
Mailing Address - Phone:620-778-2213
Mailing Address - Fax:
Practice Address - Street 1:3230 WISCONSIN AVE STE A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4073
Practice Address - Country:US
Practice Address - Phone:417-347-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999141340363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health