Healthcare Provider Details

I. General information

NPI: 1295733103
Provider Name (Legal Business Name): INSTITUTE FOR BEAUTY AND WOMEN'S HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PACIFIC
BRANSON MO
65616
US

IV. Provider business mailing address

590 W PACIFIC
BRANSON MO
65616
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-2080
  • Fax: 417-335-2080
Mailing address:
  • Phone: 417-335-2080
  • Fax: 417-336-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35042
License Number StateMO

VIII. Authorized Official

Name: DR. ROY P NERMARK
Title or Position: PHYSICIAN
Credential: MD OBGYN
Phone: 417-335-2080