Healthcare Provider Details

I. General information

NPI: 1881836757
Provider Name (Legal Business Name): ANITA LYN ARNOLD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E QUINCY ST
LEWISTOWN MO
63452-2560
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4038
US

V. Phone/Fax

Practice location:
  • Phone: 573-215-2715
  • Fax: 573-497-2322
Mailing address:
  • Phone: 217-222-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA102156
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008003
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2000145907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: