Provider Demographics
NPI:1992367213
Name:BAY, SHANNON MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:BAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MICHELLE
Other - Last Name:LEFTRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1400 US HIGHWAY 61 STE G50
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4142
Mailing Address - Country:US
Mailing Address - Phone:314-366-4874
Mailing Address - Fax:314-366-4875
Practice Address - Street 1:1400 US HIGHWAY 61 STE G50
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4142
Practice Address - Country:US
Practice Address - Phone:314-366-4874
Practice Address - Fax:314-366-4875
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily