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NPI Code Detail

MEDICARE: MRS. JENNETTA SUE STEARNS FNP

MEDICARE: MRS. JENNETTA SUE STEARNS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner2022034951MO

General Provider Information

NPI Number : 1356061121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNETTA SUE STEARNS FNP
Provider Business Mailing Address
First Line : 9229 COUNTY ROAD 607
Second Line :
City : DEXTER
State : MO
Zip : 63841-8219
Country : US
Telephone Number : 573-624-1030
Fax Number :
Provider Business Practice Location Address
First Line : 806 N DOUGLASS ST
Second Line :
City : MALDEN
State : MO
Zip : 63863-1512
Country : US
Telephone Number : 573-276-3873
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2022
Last Update Date : 08/31/2022

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