Healthcare Provider Details

I. General information

NPI: 1356843296
Provider Name (Legal Business Name): AUDRIANNA NICOLE RUFFEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 10TH ST STE 301
SEDALIA MO
65301
US

IV. Provider business mailing address

601 E 14TH ST
SEDALIA MO
65301-5972
US

V. Phone/Fax

Practice location:
  • Phone: 660-827-2500
  • Fax: 660-827-2511
Mailing address:
  • Phone: 660-829-7744
  • Fax: 660-827-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018006029
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: