Individual
MOLLY J OMOHUNDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3605 COUNTRY CLUB DR, JEFFERSON CITY, MO 65109-1070
(573) 634-4878
(573) 636-3045
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2017043235
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420050202
—
MO
Enumeration date
11/20/2017
Last updated
06/28/2022
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