Healthcare Provider Details

I. General information

NPI: 1720716707
Provider Name (Legal Business Name): CLAYTON ALLSTUN BAILEY PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4066 DUNNICA AVE
SAINT LOUIS MO
63116-3510
US

IV. Provider business mailing address

2711 E LINWOOD ST
SPRINGFIELD MO
65804-1936
US

V. Phone/Fax

Practice location:
  • Phone: 636-224-1700
  • Fax: 314-535-5917
Mailing address:
  • Phone: 417-425-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022045842
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: