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Organization

FAITHWALK COMMUNITY DEVELOPMENT CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS BETTY WILSON NURSE PRACTIONER-LN# (FNP-)
(660) 327-5752
Entity
Organization

Contact information

Practice address
514 FOX ST., PARIS, MO 65275
(660) 327-5752
(660) 327-6233
Mailing address
P.O. BOX 119, 514 FOX ST., PARIS, MO 65275
(660) 327-5752
(660) 327-6233

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
101YP1600X
Pastoral Counselor
363L00000X
Nurse Practitioner
Primary
2004028021
MO

Other

Enumeration date
03/19/2014
Last updated
03/19/2014
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