Healthcare Provider Details

I. General information

NPI: 1316064199
Provider Name (Legal Business Name): NANCY K STUBBS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N INDUSTRIAL DR
HOUSTON MO
65483-9407
US

IV. Provider business mailing address

7917 MINERAL DR
HOUSTON MO
65483-1388
US

V. Phone/Fax

Practice location:
  • Phone: 417-260-5519
  • Fax:
Mailing address:
  • Phone: 417-967-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number067986
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: