MEDICARE: MRS. VIVIAN JEAN CRITES RN, FNP-BC

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	2021012137	MO

General Provider Information

NPI Number	:	1114695657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIVIAN JEAN CRITES RN, FNP-BC

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	:	225 PHYSICIANS PARK
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-3935
Country	:	US
Telephone Number	:	573-727-5500
Fax Number	:	573-727-5599

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	09/28/2021

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