Healthcare Provider Details

I. General information

NPI: 1396689857
Provider Name (Legal Business Name): AUSTIN TYLER SHILT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST STE 520
SPRINGFIELD MO
65807-7002
US

IV. Provider business mailing address

4006 S LONE PINE AVE UNIT 221
SPRINGFIELD MO
65804-6878
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-4550
  • Fax:
Mailing address:
  • Phone: 417-569-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: