=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174341705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA CARRENDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2024
-----------------------------------------------------
Last Update Date | 10/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1513 UNION AVE STE 2500
-----------------------------------------------------
City | MOBERLY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65270-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-372-1313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 MADELINES PARK DR
-----------------------------------------------------
City | JEFFERSON CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65109-7333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-821-0817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 2024038701
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------