Provider Demographics
NPI:1639953714
Name:BAILEY, SHANNON E (APRN-CNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:BAILEY
Suffix:
Gender:F
Credentials:APRN-CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1287 TERRY CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1128
Mailing Address - Country:US
Mailing Address - Phone:217-358-3035
Mailing Address - Fax:
Practice Address - Street 1:1251 NILLES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7206
Practice Address - Country:US
Practice Address - Phone:513-939-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.458168163W00000X
OHAPRN.CNP.0036463363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse