Healthcare Provider Details

I. General information

NPI: 1376515080
Provider Name (Legal Business Name): DEBRA A ATKINSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA A CADA

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 BAGNELL DAM BLVD
LAKE OZARK MO
65049-8658
US

IV. Provider business mailing address

67 SILVER CREEK LN
ELDON MO
65026-5430
US

V. Phone/Fax

Practice location:
  • Phone: 573-365-2318
  • Fax: 573-365-3009
Mailing address:
  • Phone: 573-280-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2000162958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: