NPI 1962043802 · live from the CMS NPI Registry
Bonne Terre Healthcare Clinic LLC
Nurse Practitioner, Family in Bonne Terre, MO. National Provider Identifier 1962043802, active.
NPI record
| NPI | 1962043802 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 11 S Division St Ste A, Bonne Terre, MO 63628 |
| Practice phone | 573-723-1100 |
| Enumerated | October 2, 2019 |
| Last updated | February 25, 2024 |
| Authorized official | Mary Chandler, Owner/Provider |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Mental Health | 101YM0800X | — |
| Nurse Practitioner, Pediatrics | 363LP0200X | — |
| Nurse Practitioner, Psych/Mental Health | 363LP0808X | — |
| Nurse Practitioner, Primary Care | 363LP2300X | — |
| Nurse Practitioner, Women's Health | 363LW0102X | — |
| Nurse Practitioner, Family primary | 363LF0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.