Healthcare Provider Details

I. General information

NPI: 1235457276
Provider Name (Legal Business Name): MRS. DOROTHY ANN PEERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2010
Last Update Date: 05/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 COUNTY ROAD 420
FULTON MO
65251-6773
US

IV. Provider business mailing address

5515 COUNTY ROAD 420
FULTON MO
65251-6773
US

V. Phone/Fax

Practice location:
  • Phone: 573-355-1489
  • Fax:
Mailing address:
  • Phone: 573-355-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberS036235006
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: