Boles, Shannon Kristine

Boles, Shannon Kristine is an individual health care provider with primary practice located at 4901 Forest Park Ave Div Surg Accs, Ste 340, Saint Louis MO 63108-1495. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Boles, Shannon Kristine can be contacted via phone (314) 362-5298.

Contact Information

Primary practice address
4901 Forest Park Ave Div Surg Accs, Ste 340 Saint Louis MO 63108-1495
Phone: (314) 362-5298
Fax: (888) 824-2176
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 2000165054 Missouri

Profile Details

NPI number 1760552665
LBN Legal business name Boles, Shannon Kristine
Credentials ACNP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2006
Last updated Apr 25th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760552665 NPPES
Missouri MEDICAID 420007468

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