Healthcare Provider Details

I. General information

NPI: 1821052853
Provider Name (Legal Business Name): GAIL COMPTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 RE HIGHWAY 54
CAMDENTON MO
65020
US

IV. Provider business mailing address

940 EXECUTIVE DR
OSAGE BEACH MO
65065-3497
US

V. Phone/Fax

Practice location:
  • Phone: 573-317-1150
  • Fax: 573-317-1151
Mailing address:
  • Phone: 573-302-7891
  • Fax: 573-302-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number149317
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: