Healthcare Provider Details

I. General information

NPI: 1821519430
Provider Name (Legal Business Name): SUMMER WARREN GEORGE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMMER WARREN CARGILL FNP-C

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S BISHOP AVE
ROLLA MO
65401-4320
US

IV. Provider business mailing address

603 S BISHOP AVE
ROLLA MO
65401-4314
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-4411
  • Fax: 573-426-4403
Mailing address:
  • Phone: 573-458-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-213351
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134323
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024028755
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: