Healthcare Provider Details

I. General information

NPI: 1215022397
Provider Name (Legal Business Name): GALE E ROBERTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GALE E COOK RN

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 W MARLER LN
OZARK MO
65721-7661
US

IV. Provider business mailing address

3800 S NATIONAL AVE #540
SPRINGFIELD MO
65807-5209
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-3006
  • Fax: 417-581-3009
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN083179
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: