Individual
JEANNIE M. CARLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
54 HOSPITAL DR, SUITE 102, OSAGE BEACH, MO 65065-3050
(573) 348-8045
(573) 348-8046
Mailing address
840 PASSOVER RD, OSAGE BEACH, MO 65065-2834
(573) 723-5157
(573) 693-1680
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
111554
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134265556
—
MO
01
—
431560263
TRICARE
MO
01
—
500023720
RR MCR
MO
Enumeration date
01/30/2007
Last updated
09/21/2020
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