Individual
STEPHANIE L NIMMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
118 W DALLAS ST, BUFFALO, MO 65622-8669
(417) 345-6101
Mailing address
118 W DALLAS ST, BUFFALO, MO 65622-8669
(855) 420-7900
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2005006620
MO
363LF0000X
Family Nurse Practitioner
Primary
2017023153
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE
MO
05
—
PENDING
—
MO
Enumeration date
06/19/2017
Last updated
07/14/2017
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