Healthcare Provider Details

I. General information

NPI: 1003254087
Provider Name (Legal Business Name): ERIN ELIZABETH DUVALL APRN, FNP-C, PMHNP-B
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E BENNETT - B
SPRINGFIELD MO
65804-6580
US

IV. Provider business mailing address

1059 BARTON DR
FORDLAND MO
65652-7350
US

V. Phone/Fax

Practice location:
  • Phone: 417-619-4129
  • Fax:
Mailing address:
  • Phone: 417-767-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013017565
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2013017565
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2013017565
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: