Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 101191 | MO |
NPI | 1003812090 |
---|---|
Provider Name | Karen A Sylvara |
First Address | Kirksville, MO 63501-3728 |
Second Address | Kirksville, MO 63501-3728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 25/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
243370202 | (05) | MO |
F27953 | (02) | MO |