Healthcare Provider Details

I. General information

NPI: 1902390180
Provider Name (Legal Business Name): ELISE CATHERINE PILGER AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 BINGHAM RD
BOONVILLE MO
65233-2229
US

IV. Provider business mailing address

1742 W WOODIE PROCTOR RD
COLUMBIA MO
65203-8886
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-8018
  • Fax:
Mailing address:
  • Phone: 573-424-2421
  • Fax: 660-882-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018021112
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: