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NPI Code Detail

MEDICARE: SHANE AUSTIN STANFORD ACAGNP

MEDICARE: SHANE AUSTIN STANFORD ACAGNP
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
1363LA2100XAcute Care Nurse Practitioner2026001767MO

General Provider Information

NPI Number : 1871452680
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE AUSTIN STANFORD ACAGNP
Provider Business Mailing Address
First Line : 6000 HOSPITAL DR
Second Line :
City : HANNIBAL
State : MO
Zip : 63401-6887
Country : US
Telephone Number : 573-248-1300
Fax Number :
Provider Business Practice Location Address
First Line : 6000 HOSPITAL DR
Second Line :
City : HANNIBAL
State : MO
Zip : 63401-6887
Country : US
Telephone Number : 573-248-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2026
Last Update Date : 01/17/2026

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Directions to “ SHANE AUSTIN STANFORD ACAGNP” Practice Location

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