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General NPI Number Information
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NPI Number | 1750424693
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Entity Type | Organization
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Legal Business Name | COMMUNITY HOSPITAL ASSOCIATION FNP GROUP
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 26136 US HIGHWAY 59
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City | FAIRFAX
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State | MO
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Zip | 64446-9105
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Country | US
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Telephone | 660-686-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 405 E MAIN ST PO BOX 107
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City | FAIRFAX
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State | MO
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Zip | 64446-8155
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Country | US
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Telephone | 660-686-2211
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JULIE JONES
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Credential |
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Telephone | 660-686-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 102-48
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License Number State | MO
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