Healthcare Provider Details

I. General information

NPI: 1881836021
Provider Name (Legal Business Name): EAST MISSOURI ACTION AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LINDEN ST
CAPE GIRARDEAU MO
63703-7708
US

IV. Provider business mailing address

PO BOX 308 403 PARKWAY DRIVE
PARK HILLS MO
63601-0308
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-2516
  • Fax: 573-334-4416
Mailing address:
  • Phone: 573-334-2516
  • Fax: 573-334-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number2002005956
License Number StateMO

VIII. Authorized Official

Name: MISS ANGEL G PRATHER
Title or Position: FAMILY PLANNING DIRECTOR
Credential:
Phone: 573-431-5191