Healthcare Provider Details

I. General information

NPI: 1639953714
Provider Name (Legal Business Name): SHANNON E BAILEY APRN-CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NILLES RD
FAIRFIELD OH
45014-7206
US

IV. Provider business mailing address

1287 TERRY CT
MASON OH
45040-1128
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 217-358-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0036463
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.458168
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: