Healthcare Provider Details

I. General information

NPI: 1356061121
Provider Name (Legal Business Name): JENNETTA SUE STEARNS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N DOUGLASS ST
MALDEN MO
63863-1512
US

IV. Provider business mailing address

9229 COUNTY ROAD 607
DEXTER MO
63841-8219
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-3873
  • Fax:
Mailing address:
  • Phone: 573-624-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022034951
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: