Facts
- Status
- A
- Credential
- DC
- Type
- Individual
- Enumeration date
- 2018-10-29
- Last updated
- 2021-10-26
Specialties
Licenses
- License MO
- 2018093283
Location
- Practice location
- 918 MAIN ST
- City
- LEXINGTON MO
- Postal code
- 640671343
- Phone
- 660-251-4055
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.