MEDICARE: MRS. JANELLE S CARRON FNP

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	363LF0000X	Family Nurse Practitioner	086277	MO

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

General Provider Information

NPI Number	:	1073519773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANELLE S CARRON FNP

Provider Business Mailing Address
First Line	:	722 N HIGHWAY 47
Second Line	:	STE B
City	:	WARRENTON
State	:	MO
Zip	:	63383-1108
Country	:	US
Telephone Number	:	636-456-3413
Fax Number	:	636-456-7238

Provider Business Practice Location Address
First Line	:	722 N HIGHWAY 47
Second Line	:	STE B
City	:	WARRENTON
State	:	MO
Zip	:	63383-1108
Country	:	US
Telephone Number	:	636-456-3413
Fax Number	:	636-456-7238

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	03/27/2012

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