Healthcare Provider Details

I. General information

NPI: 1437474293
Provider Name (Legal Business Name): SUMMER R MASTERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

IV. Provider business mailing address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

V. Phone/Fax

Practice location:
  • Phone: 660-686-2211
  • Fax:
Mailing address:
  • Phone: 660-686-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-102286-032
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2007006533
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75115-032
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010009569
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: