MEDICARE: CHERYL CALVIN APRN, BC 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
1	363LF0000X	Family Nurse Practitioner	64430	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000000	OTHER	MO	NO NUMER AVAILABLE

General Provider Information

NPI Number	:	1518070283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL CALVIN APRN, BC FNP

Provider Business Mailing Address
First Line	:	43 OLD MILL LN
Second Line	:
City	:	SOUTH GREENFIELD
State	:	MO
Zip	:	65752-7173
Country	:	US
Telephone Number	:	417-637-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W PATTERSON ST
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1054
Country	:	US
Telephone Number	:	417-466-7700
Fax Number	:	417-466-7754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	12/18/2009

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