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General NPI Number Information
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NPI Number | 1336792563
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Entity Type | Individual
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Provider Name | JEREMY SCOTT LAWSON MSN, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 213 S WALNUT ST
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City | STEELE
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State | MO
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Zip | 63877-1714
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Country | US
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Telephone | 573-695-2748
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Fax |
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Provider Business Mailing Address
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Address Line | 1961 STATE HIGHWAY A
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City | WARDELL
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State | MO
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Zip | 63879-9141
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2019022990
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License Number State | MO
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