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NPI Code Detail

MEDICARE: DEBRA S PRICE FNP

MEDICARE: DEBRA S PRICE 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner089868MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1500003495OTHERTRAVELERS MEDICARE

General Provider Information

NPI Number : 1114905346
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA S PRICE FNP
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 : 686 LESTER ST
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-5025
Country : US
Telephone Number : 573-686-2411
Fax Number : 573-778-7271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 03/04/2021

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