Healthcare Provider Details

I. General information

NPI: 1154299923
Provider Name (Legal Business Name): VIRGINIA ELLEN BUFFINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 US 60
VAN BUREN MO
63965
US

IV. Provider business mailing address

1011 US 60
VAN BUREN MO
63965
US

V. Phone/Fax

Practice location:
  • Phone: 573-323-2171
  • Fax:
Mailing address:
  • Phone: 573-323-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number052892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: