Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 059306 | MO |
NPI | 1013064898 |
---|---|
Provider Name | Mrs. Patricia Kay Bouse |
First Address | Clinton, MO 64735-9442 |
Second Address | Appleton City, MO 64724-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070058 | (05) | MO |
29823019PIN 29824017 | (05) | MO |