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General NPI Number Information
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NPI Number | 1912524059
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Entity Type | Individual
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Provider Name | FARAH LYNN SHADDIX MSN, RN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/05/2020
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 401 CHURCH ST UNIT 791
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City | O FALLON
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State | MO
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Zip | 63366-6506
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Country | US
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Telephone | 636-388-4170
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Fax | 636-306-4267
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Provider Business Mailing Address
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Address Line | 1103 WARM WINDS DR
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City | O FALLON
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State | MO
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Zip | 63366-6327
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Country | US
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Telephone | 636-388-4170
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Fax | 636-306-4267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2020019555
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License Number State | MO
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