Provider Demographics
NPI:1013637735
Name:SHANNON, LYNDSEY ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:ELIZABETH
Last Name:SHANNON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:
Other - Last Name:GAMBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:210 PORTLAND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6677
Mailing Address - Country:US
Mailing Address - Phone:573-777-8818
Mailing Address - Fax:573-777-8819
Practice Address - Street 1:210 PORTLAND ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6677
Practice Address - Country:US
Practice Address - Phone:573-777-8818
Practice Address - Fax:573-777-8819
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022031214363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily