Healthcare Provider Details

I. General information

NPI: 1831754720
Provider Name (Legal Business Name): AUDREY ANNE HUBLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N BROADWAY ST
SOUTH WEST CITY MO
64863-9417
US

IV. Provider business mailing address

109 N BROADWAY ST
SOUTH WEST CITY MO
64863-9417
US

V. Phone/Fax

Practice location:
  • Phone: 417-762-3287
  • Fax: 417-762-3255
Mailing address:
  • Phone: 417-762-3287
  • Fax: 417-762-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA188081
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019010401
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18059-33
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14033
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.035329
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0040833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: