Healthcare Provider Details

I. General information

NPI: 1780421222
Provider Name (Legal Business Name): SHANNON KROH APRN, WHNP-BC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HIGHWAY K
O FALLON MO
63366-8431
US

IV. Provider business mailing address

8626 N WATSON AVE
KANSAS CITY MO
64153-3660
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-6363
  • Fax:
Mailing address:
  • Phone: 402-715-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2024030414
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2022028693
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: