MEDICARE: JANE B STONNER 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	058560	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00125467	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	27276	OTHER		BCBS

General Provider Information

NPI Number	:	1871690172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE B STONNER APRN

Provider Business Mailing Address
First Line	:	11863 STATE HIGHWAY 13
Second Line	:	PO BOX 555
City	:	KIMBERLING CITY
State	:	MO
Zip	:	65686-8362
Country	:	US
Telephone Number	:	417-739-1995
Fax Number	:	417-739-1893

Provider Business Practice Location Address
First Line	:	11016 E STATE HIGHWAY 76
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-9775
Country	:	US
Telephone Number	:	417-272-0400
Fax Number	:	417-272-0428

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/26/2016

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