Healthcare Provider Details

I. General information

NPI: 1073449658
Provider Name (Legal Business Name): MISTY DAWN STOPPER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 STELLA ST
LEBANON MO
65536-4282
US

IV. Provider business mailing address

736 STELLA ST
LEBANON MO
65536-4282
US

V. Phone/Fax

Practice location:
  • Phone: 417-733-7324
  • Fax:
Mailing address:
  • Phone: 417-733-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026028657
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: