Healthcare Provider Details

I. General information

NPI: 1043796444
Provider Name (Legal Business Name): STEPHANIE ANN WHITBEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EAST BROADWAY
COLUMBIA MO
65201-5844
US

IV. Provider business mailing address

1600 EAST BROADWAY
COLUMBIA MO
65201-5844
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8000
  • Fax: 573-815-8556
Mailing address:
  • Phone: 573-815-8000
  • Fax: 573-815-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2004005170
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018027760
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2018027760
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: