Healthcare Provider Details

I. General information

NPI: 1700525839
Provider Name (Legal Business Name): MINDY TRISLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18452 BUSINESS 13
BRANSON WEST MO
65737-9609
US

IV. Provider business mailing address

PO BOX 505673
SAINT LOUIS MO
63150-5673
US

V. Phone/Fax

Practice location:
  • Phone: 417-272-8911
  • Fax: 417-330-2229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022017078
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: