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General NPI Number Information
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NPI Number | 1205053758
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Entity Type | Individual
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Provider Name | FARRAH TRAQUEL MCSPADDEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1013 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5043
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Country | US
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Telephone | 573-472-7535
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Fax | 573-472-7787
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Provider Business Mailing Address
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Address Line | 1013 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5043
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Country | US
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Telephone | 573-472-7535
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Fax | 573-472-7787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
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License Number | 4301086477
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2009023901
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License Number State | MO
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