Healthcare Provider Details

I. General information

NPI: 1356007363
Provider Name (Legal Business Name): SHANNON DENISE ASHWORTH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR # 58.00
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR # 58.00
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4438
  • Fax: 573-884-9992
Mailing address:
  • Phone: 573-882-4438
  • Fax: 573-884-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025024892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: