MEDICARE: STEPHANIE ANNE DOTY FNP-C

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	363LP2300X	Primary Care Nurse Practitioner	2025041925	MO

General Provider Information

NPI Number	:	1952271900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ANNE DOTY FNP-C

Provider Business Mailing Address
First Line	:	506 N CHICAGO AVE
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-1724
Country	:	US
Telephone Number	:	417-298-1042
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 W BATTLEFIELD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-4123
Country	:	US
Telephone Number	:	417-413-5900
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	03/25/2026

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