Facts
- Status
- A
- Credential
- FNP
- Type
- Individual
- Enumeration date
- 2021-04-19
- Last updated
- 2023-01-05
Licenses
- License MO
- 2021026205
- License MO
- 2016019155
- License MO
- 2021026205
Location
- Practice location
- 408 E 7TH ST
- City
- APPLETON CITY MO
- Postal code
- 647241617
- Phone
- 660-476-2121
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.