Healthcare Provider Details

I. General information

NPI: 1962814434
Provider Name (Legal Business Name): ELIZABETH KERMIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 COLUMBIA AVE
OSAGE BEACH MO
65065-8689
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-7490
  • Fax: 573-302-7895
Mailing address:
  • Phone: 573-708-7600
  • Fax: 573-723-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number295855
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2023029401
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: