Individual
SWE MYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2600
(417) 820-2100
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2012017206
MO
207R00000X
Internal Medicine Physician
Primary
A118620
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447480108
—
MO
05
—
193711001
—
AR
01
—
431560263
TRICARE
MO
01
—
P01077564
RR MCR
MO
Enumeration date
07/16/2009
Last updated
10/13/2025
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