Healthcare Provider Details

I. General information

NPI: 1699760850
Provider Name (Legal Business Name): DEANNA LEE BINGHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 TEACO RD
KENNETT MO
63857-3721
US

IV. Provider business mailing address

RAF LAKENHEATH 48 MDG/SGHC UNIT 5115
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-0444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAO1816
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: