Provider Demographics
NPI:1932826971
Name:SHINN, STACY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:SHINN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 S CEDARBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2726
Mailing Address - Country:US
Mailing Address - Phone:314-825-0200
Mailing Address - Fax:
Practice Address - Street 1:2240 W SUNSET ST STE 104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6041
Practice Address - Country:US
Practice Address - Phone:417-269-4663
Practice Address - Fax:417-269-9281
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009033402163W00000X
MO2022042408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse