Healthcare Provider Details

I. General information

NPI: 1871690172
Provider Name (Legal Business Name): JANE B STONNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11016 E STATE HIGHWAY 76
BRANSON WEST MO
65737-9775
US

IV. Provider business mailing address

11863 STATE HIGHWAY 13 PO BOX 555
KIMBERLING CITY MO
65686-8362
US

V. Phone/Fax

Practice location:
  • Phone: 417-272-0400
  • Fax: 417-272-0428
Mailing address:
  • Phone: 417-739-1995
  • Fax: 417-739-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number058560
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: