Healthcare Provider Details

I. General information

NPI: 1245471994
Provider Name (Legal Business Name): ELAINE BLEVINS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST SUITE 320 A & B
SPRINGFIELD MO
65807-5154
US

IV. Provider business mailing address

1000 E PRIMROSE ST SUITE 320 A & B
SPRINGFIELD MO
65807-5154
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2300
  • Fax: 417-269-2307
Mailing address:
  • Phone: 417-269-2300
  • Fax: 417-269-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number153837
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: