Healthcare Provider Details

I. General information

NPI: 1336792563
Provider Name (Legal Business Name): JEREMY SCOTT LAWSON MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S WALNUT ST
STEELE MO
63877-1714
US

IV. Provider business mailing address

1961 STATE HIGHWAY A
WARDELL MO
63879-9141
US

V. Phone/Fax

Practice location:
  • Phone: 573-695-2748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019022990
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: