Healthcare Provider Details

I. General information

NPI: 1578095873
Provider Name (Legal Business Name): LANDRY PAXTON STRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N KENTUCKY AVE
WEST PLAINS MO
65775-2029
US

IV. Provider business mailing address

PO BOX 1100
WEST PLAINS MO
65775
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-9111
  • Fax:
Mailing address:
  • Phone: 870-377-1921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2017016080
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: