Individual
AGATHE MCEACHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
107 ICHORD AVE, WAYNESVILLE, MO 65583-5401
(573) 774-2715
(573) 774-2792
Mailing address
PO BOX 579, ROLLA, MO 65402-0579
(573) 774-2715
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
153033
MO
363L00000X
Nurse Practitioner
153033
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153033
LICENSE
—
Enumeration date
08/13/2007
Last updated
12/03/2009
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