Healthcare Provider Details

I. General information

NPI: 1356369714
Provider Name (Legal Business Name): CAROL J CONSTANT APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 11TH ST SUITE 11
CHILLICOTHEE MO
64601-1676
US

IV. Provider business mailing address

PO BOX 316
CHILLICOTHEE MO
64601-0316
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-6411
  • Fax: 660-646-5881
Mailing address:
  • Phone: 660-646-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number99778
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: