Healthcare Provider Details

I. General information

NPI: 1255765822
Provider Name (Legal Business Name): BERNADETTE ROSE HUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERNADETTE ROSE SAMSON HUSTON ACNS

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S MOUNT AUBURN RD
CAPE GIRARDEAU MO
63703-4914
US

IV. Provider business mailing address

PO BOX 801143
KANSAS CITY MO
64180-1143
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-3350
  • Fax: 573-331-3351
Mailing address:
  • Phone: 573-331-5583
  • Fax: 573-331-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2013005397
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: