Healthcare Provider Details

I. General information

NPI: 1154304624
Provider Name (Legal Business Name): IVETTE C TURNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W CLAY RD
VERSAILLES MO
65084-1177
US

IV. Provider business mailing address

210 N MARKET ST
MILAN MO
63556-1316
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-2349
  • Fax: 888-979-8868
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1K66
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR1K66
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: