Healthcare Provider Details

I. General information

NPI: 1609405786
Provider Name (Legal Business Name): MRS. TERRISSA MARIE NEIMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BROADWAY
COLUMBIA MO
65201-5844
US

IV. Provider business mailing address

2409 STRATFORD CHASE PKWY
COLUMBIA MO
65201-7162
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8000
  • Fax:
Mailing address:
  • Phone: 573-263-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2015005319
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: