Individual
MR. BAILEY SHANNON VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9556 MANCHESTER RD, SAINT LOUIS, MO 63119-1313
(314) 373-5740
Mailing address
12541 WESTPORT DR, SAINT LOUIS, MO 63146-3857
(573) 614-2810
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2024007399
MO
Other
Enumeration date
02/29/2024
Last updated
05/08/2026
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