Healthcare Provider Details

I. General information

NPI: 1497584288
Provider Name (Legal Business Name): DEVON ELYSE TROUT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST
SPRINGFIELD MO
65807-5154
US

IV. Provider business mailing address

4668 S MARY ANN AVE
SPRINGFIELD MO
65810-1028
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-4037
  • Fax:
Mailing address:
  • Phone: 417-838-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024030420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: