Healthcare Provider Details

I. General information

NPI: 1063999464
Provider Name (Legal Business Name): SHAY DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINDY SHAY BENNINGHOVEN

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E GRAND ST
SPRINGFIELD MO
65807-1447
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5600
  • Fax:
Mailing address:
  • Phone: 417-761-5214
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018027297
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: