Provider Demographics
NPI:1912560038
Name:SHUNYAKOV, BAILEY (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:SHUNYAKOV
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:RUNDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:785-823-0633
Mailing Address - Fax:844-854-4662
Practice Address - Street 1:1501 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3020
Practice Address - Country:US
Practice Address - Phone:417-326-7200
Practice Address - Fax:417-326-7201
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019019267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner