Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 110296 | MO |
NPI | 1013140847 |
---|---|
Provider Name | Lisa M Byrd |
First Address | Columbia, MO 65201-8023 |
Second Address | Columbia, MO 65201-8023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2009 |
Last Update Date | 22/09/2021 |