Healthcare Provider Details

I. General information

NPI: 1891147104
Provider Name (Legal Business Name): DEBBY SUE CARL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 BARTON DR
FORDLAND MO
65652-7350
US

IV. Provider business mailing address

112 ALAN DR
ROGERSVILLE MO
65742-8792
US

V. Phone/Fax

Practice location:
  • Phone: 417-776-7227
  • Fax:
Mailing address:
  • Phone: 417-766-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016021267
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: