Healthcare Provider Details

I. General information

NPI: 1467374934
Provider Name (Legal Business Name): BAILIE SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 LAKE AIR DR
WACO TX
76710-5756
US

IV. Provider business mailing address

648 HERITAGE PKWY
AXTELL TX
76624-1108
US

V. Phone/Fax

Practice location:
  • Phone: 254-269-3099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1073332
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: