MEDICARE: JERRIANN COXSON CFNP

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	363L00000X	Nurse Practitioner	2004027939	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00223109	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1386619252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRIANN COXSON CFNP

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1359
Country	:	US
Telephone Number	:	417-683-4831
Fax Number	:	417-683-1602

Provider Business Practice Location Address
First Line	:	504 NW 10TH AVE
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608
Country	:	US
Telephone Number	:	417-683-4831
Fax Number	:	417-683-1602

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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