Healthcare Provider Details

I. General information

NPI: 1619919198
Provider Name (Legal Business Name): BARBARA E WOTHERSPOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W SUNSET RD STE 202
LAS VEGAS NV
89113-1981
US

IV. Provider business mailing address

222 E PRIMROSE ST STE E
SPRINGFIELD MO
65807-5233
US

V. Phone/Fax

Practice location:
  • Phone: 702-514-1411
  • Fax: 702-514-1413
Mailing address:
  • Phone: 814-274-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD427407
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2007015351
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: