Shannon Vyctoriah Taylor Feurt

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Fayette, MO

NPI 1144764580 · NPPES record last updated Dec 5, 2016

Key facts

NPI
1144764580
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
411 Central Methodist SQ
Fayette, MO 65248-1104
Phone
(816) 718-5956
NPI assigned
Dec 5, 2016
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

411 Central Methodist SQ
Fayette, MO 65248-1104

Mailing address

30305 S Little Rd
Garden City, MO 64747-9770
Phone (816) 718-5956

Other providers in Fayette, MO

All providers in Fayette, MO · Student in an Organized Health Care Education/Training Program in Missouri

Sources for this page

Verify at the official NPI Registry.