MEDICARE: CAROL J CONSTANT APRN, 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	99778	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	:	1356369714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL J CONSTANT APRN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 316
Second Line	:
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-0316
Country	:	US
Telephone Number	:	660-646-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 11TH ST
Second Line	:	SUITE 11
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-1676
Country	:	US
Telephone Number	:	660-646-6411
Fax Number	:	660-646-5881

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/16/2009

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