Healthcare Provider Details

I. General information

NPI: 1639005762
Provider Name (Legal Business Name): SHENA LEE STEVENSON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BUSINESS ROUTE 63
THAYER MO
65791-7748
US

IV. Provider business mailing address

913 S STATE ROUTE 17
MOUNTAIN VIEW MO
65548-8288
US

V. Phone/Fax

Practice location:
  • Phone: 417-264-7256
  • Fax: 417-264-3219
Mailing address:
  • Phone: 417-264-7256
  • Fax: 417-264-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2026019481
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: