Healthcare Provider Details

I. General information

NPI: 1023094240
Provider Name (Legal Business Name): BETH M SCHRAGE RNCSFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH M MACKEY

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E JACKSON ST
EDINA MO
63537-1335
US

IV. Provider business mailing address

1416 CROWN DRIVE
KIRKSVILLE MO
63501-2548
US

V. Phone/Fax

Practice location:
  • Phone: 660-397-3571
  • Fax: 660-397-2307
Mailing address:
  • Phone: 660-627-5757
  • Fax: 660-627-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number107529
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107529
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: