Healthcare Provider Details

I. General information

NPI: 1487132056
Provider Name (Legal Business Name): BETH METTES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2018
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MCKAY ST
MACON MO
63552-2029
US

IV. Provider business mailing address

31692 STATE HIGHWAY DD
MACON MO
63552-3119
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-3141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018028689
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018028689
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: