Healthcare Provider Details

I. General information

NPI: 1295895597
Provider Name (Legal Business Name): LINDA SUE COKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 STATE HIGHWAY 248 SUITE #1
BRANSON MO
65616-9241
US

IV. Provider business mailing address

2404 STATE HIGHWAY 248 SUITE #1
BRANSON MO
65616-9241
US

V. Phone/Fax

Practice location:
  • Phone: 417-339-2535
  • Fax: 417-339-2634
Mailing address:
  • Phone: 417-339-2535
  • Fax: 417-339-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number065595
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002537
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: