Provider Demographics
NPI:1215764113
Name:ALEXANDER, SHYNESE BRIANA LAKAY'LYNN
Entity type:Individual
Prefix:
First Name:SHYNESE
Middle Name:BRIANA LAKAY'LYNN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W BUSINESS LOOP 70 STE 214B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2566
Mailing Address - Country:US
Mailing Address - Phone:573-289-7667
Mailing Address - Fax:
Practice Address - Street 1:601 W BUSINESS LOOP 70 STE 214B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2566
Practice Address - Country:US
Practice Address - Phone:573-289-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOUV202193374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula