Healthcare Provider Details

I. General information

NPI: 1912962291
Provider Name (Legal Business Name): SUSAN L BYERLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 VIBURNUM CENTER RD
VIBURNUM MO
65566-7802
US

IV. Provider business mailing address

110 S 2ND ST
ELLINGTON MO
63638-9400
US

V. Phone/Fax

Practice location:
  • Phone: 573-244-5406
  • Fax: 573-244-5591
Mailing address:
  • Phone: 573-663-2313
  • Fax: 573-663-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number131216
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: