Healthcare Provider Details

I. General information

NPI: 1518628163
Provider Name (Legal Business Name): TAMMY DOERHOFF FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 COUNTRY MEADOW LN
FULTON MO
65251-5278
US

IV. Provider business mailing address

350 COUNTRY MEADOW LN
FULTON MO
65251-5278
US

V. Phone/Fax

Practice location:
  • Phone: 573-634-4878
  • Fax: 573-606-4549
Mailing address:
  • Phone: 573-634-4878
  • Fax: 573-606-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021051163
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: