Healthcare Provider Details

I. General information

NPI: 1023665429
Provider Name (Legal Business Name): SHANNON RHEA SITZMANN DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON RHEA HEADY

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 PERUQUE CROSSING CT STE 101B
O FALLON MO
63366-2381
US

IV. Provider business mailing address

1002 PERUQUE CROSSING CT STE 101B
O FALLON MO
63366-2381
US

V. Phone/Fax

Practice location:
  • Phone: 636-733-4252
  • Fax: 636-206-8396
Mailing address:
  • Phone: 636-733-4252
  • Fax: 636-206-8396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019030793
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: