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General NPI Number Information
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NPI Number | 1366956963
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Entity Type | Individual
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Provider Name | MOLLY J OMOHUNDRO APRN
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Gender | Female
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 3605 COUNTRY CLUB DR
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-1070
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Country | US
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Telephone | 573-634-4878
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Fax | 573-636-3045
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Provider Business Mailing Address
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Address Line | PO BOX 104240
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City | JEFFERSON CITY
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State | MO
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Zip | 65110-4240
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Country | US
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Telephone | 573-635-5264
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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 | 2017043235
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License Number State | MO
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