Healthcare Provider Details

I. General information

NPI: 1033652045
Provider Name (Legal Business Name): TRISHA VIGNA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRISHA ANDREWS APRN

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MEDICAL DR
GAINESVILLE MO
65655-8133
US

IV. Provider business mailing address

37 MEDICAL DRIVE
GAINESVILLE MO
65655
US

V. Phone/Fax

Practice location:
  • Phone: 417-679-4613
  • Fax: 417-679-2211
Mailing address:
  • Phone: 417-679-4613
  • Fax: 417-679-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018029753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: