Healthcare Provider Details

I. General information

NPI: 1538740261
Provider Name (Legal Business Name): LINDY MARIE BRESHEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W 2ND ST
SALISBURY MO
65281-1405
US

IV. Provider business mailing address

1515 UNION AVE
MOBERLY MO
65270-9407
US

V. Phone/Fax

Practice location:
  • Phone: 660-388-7084
  • Fax: 660-388-7087
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2015035769
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021018304
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: