MEDICARE: MICHELLE RENEE NASH FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2020001739	MO
2	363LF0000X	Family Nurse Practitioner	2018035951	MO

General Provider Information

NPI Number	:	1356982896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENEE NASH FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 735378
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5378
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 GRAND CANYON DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-2161
Country	:	US
Telephone Number	:	573-756-8911
Fax Number	:	573-315-3824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	12/11/2025

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