Individual
MR. CRAIG TATOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
HWY 72 N PHYSICIANS OFFICE BUILDING II, SALEM, MO 65560
(573) 729-6112
(573) 729-4035
Mailing address
PO BOX 69, SALEM, MO 65560-0069
(573) 729-6112
(573) 729-4035
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
128312
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128312
STATE LICENSE
MO
01
—
2008004369
ANCC CERTIFICATION
—
Enumeration date
09/03/2008
Last updated
09/03/2008
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