Healthcare Provider Details

I. General information

NPI: 1679113708
Provider Name (Legal Business Name): MICHELLE LOUISE BAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W GRAND ST
SPRINGFIELD MO
65802-4967
US

IV. Provider business mailing address

PO BOX 735378
CHICAGO IL
60673-5378
US

V. Phone/Fax

Practice location:
  • Phone: 417-864-4545
  • Fax:
Mailing address:
  • Phone: 877-787-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2019002146
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019002146
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: