Healthcare Provider Details

I. General information

NPI: 1437604592
Provider Name (Legal Business Name): JAMIE O'FARRELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 7TH ST
APPLETON CITY MO
64724-1617
US

IV. Provider business mailing address

408 E 7TH ST
APPLETON CITY MO
64724-1617
US

V. Phone/Fax

Practice location:
  • Phone: 660-476-2121
  • Fax:
Mailing address:
  • Phone: 660-476-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016027013
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: