Healthcare Provider Details

I. General information

NPI: 1427058007
Provider Name (Legal Business Name): ELIZABETH A. GEDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W WORLEY ST FAMILY HEALTH CENTER OF BOONE COUNTY
COLUMBIA MO
65203-2037
US

IV. Provider business mailing address

1001 W WORLEY ST FAMILY HEALTH CENTER OF BOONE COUNTY
COLUMBIA MO
65203-2037
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-2314
  • Fax: 573-607-2885
Mailing address:
  • Phone: 573-214-2314
  • Fax: 573-607-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number056827
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: