MEDICARE: PATRICIA ALEXA SUMMERFORD APRN

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	129188	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00852026	OTHER	MO	PALMETTO GBA/RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669430575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ALEXA SUMMERFORD APRN

Provider Business Mailing Address
First Line	:	PO BOX 505164
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-5164
Country	:	US
Telephone Number	:	417-829-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 EAST HIGHWAY 60
Second Line	:
City	:	MOUNTAIN VIEW
State	:	MO
Zip	:	65548-7381
Country	:	US
Telephone Number	:	417-934-2251
Fax Number	:	417-934-2871

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/26/2014

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