Vivian Dudley
Nurse Practitioner
125 N Old Hwy 66
Bourbon
, Missouri 65441
Vivian Dudley
Nurse Practitioner
125 N Old Hwy 66
Bourbon
, Missouri 65441
(573) 679-2006
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About
Features
Specialties
- Nurse Practitioner
Languages spoken
- English
Location
First Address
- Vivian Dudley
- 125 N Old Hwy 66
- Bourbon, MO
- Zip : 65441
- Phone : (573) 679-2006
Second Address
- Vivian Dudley
- 125 N Old Hwy 66
- Bourbon, MO
- Zip : 65441
- Fax : (573) 679-2009
- Phone : (573) 679-2006
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 142760 | MO |
National Provider Identifier
| NPI | 1013018654 |
|---|---|
| Provider Name | Vivian Dudley |
| First Address | Bourbon, MO 65441 |
| Second Address | Bourbon, MO 65441 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 26/09/2006 |
| Last Update Date | 25/08/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1013018654 | (05) | MO |
| 425076205 | (05) | MO |
| P01134574 | RAILROAD MEDICARE (01) | MO |
| P12747 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.