Healthcare Provider Details

I. General information

NPI: 1356801328
Provider Name (Legal Business Name): JUSTIN SCOT CORTEZ RN, MSN, APRN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S HIGHWAY 65 STE A
MARSHALL MO
65340-3735
US

IV. Provider business mailing address

PO BOX 104240
JEFFERSON CITY MO
65110-4240
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-3364
  • Fax: 660-886-6044
Mailing address:
  • Phone: 573-556-5771
  • Fax: 573-636-9756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019008162
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: