Healthcare Provider Details

I. General information

NPI: 1619091311
Provider Name (Legal Business Name): HOPE I TINKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MORRISON ST SUITE 5
FAYETTE MO
65248-1075
US

IV. Provider business mailing address

600 W MORRISON ST SUITE 5
FAYETTE MO
65248-1075
US

V. Phone/Fax

Practice location:
  • Phone: 660-248-2900
  • Fax: 660-831-3372
Mailing address:
  • Phone: 660-248-2900
  • Fax: 660-248-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8F32
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: