Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 0391 | MS |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2015044894 | MO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R895367 | MS |
NPI | 1598859688 |
---|---|
Provider Name | Dr. Sally K Adams |
First Address | Mountain Grove, MO 65711-1039 |
Second Address | Mountain Grove, MO 65711-1039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 12/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T20850 | (02) | MS |