MEDICARE: DR. CONNIE CELICIA ATCHISON DNP

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	207Q00000X	Family Medicine Physician	2023025367	MO
2	163W00000X	Registered Nurse	2016041995	MO

General Provider Information

NPI Number	:	1386321826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNIE CELICIA ATCHISON DNP

Provider Business Mailing Address
First Line	:	PO BOX 7411626
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-5626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 STATE HIGHWAY 248
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-3758
Country	:	US
Telephone Number	:	471-336-4112
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	03/05/2026

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