Organization
BROADWAY FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA JARRELL (OFFICE/BILLING SUPERVISOR)
(573) 568-7377
Entity
Organization
Contact information
Practice address
612 STATE HIGHWAY 25 S, BLOOMFIELD, MO 63825-9566
(573) 803-3995
(573) 803-5222
Mailing address
612 HWY 25 SOUTH, BLOOMFIELD, MO 63825-9566
(573) 568-7377
(573) 568-7320
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014044250
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
126560
MO
Other
Enumeration date
01/22/2018
Last updated
08/08/2023
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