MEDICARE: DR. NEFRETITI MER-EN-RA GARRISON-NORTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2011012785	MO
2	207R00000X	Internal Medicine Physician	2011012785	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00314514	OTHER	LA	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1023019015	OTHER	MO	TRIWEST

General Provider Information

NPI Number	:	1023019015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEFRETITI MER-EN-RA GARRISON-NORTH MD

Provider Business Mailing Address
First Line	:	PO BOX 801143
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1143
Country	:	US
Telephone Number	:	573-331-5583
Fax Number	:	573-331-5079

Provider Business Practice Location Address
First Line	:	211 SAINT FRANCIS DR
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-5049
Country	:	US
Telephone Number	:	573-331-5770
Fax Number	:	573-331-3974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/23/2021

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Directions to “ DR. NEFRETITI MER-EN-RA GARRISON-NORTH MD” Practice Location

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