Healthcare Provider Details

I. General information

NPI: 1346590957
Provider Name (Legal Business Name): JUSTIN T BEDFORD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 PHILIPS FARM RD
COLUMBIA MO
65201-0067
US

IV. Provider business mailing address

401 N KEENE ST
COLUMBIA MO
65201-6625
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4800
  • Fax: 573-884-0723
Mailing address:
  • Phone: 573-876-1616
  • Fax: 876-876-1678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012029887
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: