=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518070283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL CALVIN APRN, BC FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 12/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W PATTERSON ST
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65712-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-466-7700
-----------------------------------------------------
Fax | 417-466-7754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 OLD MILL LN
-----------------------------------------------------
City | SOUTH GREENFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65752-7173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-637-5458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 64430
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------