Individual
BETTY MCCULLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5344 TRAILVIEW DR, BLACK JACK, MO 63033-4645
(314) 309-7758
Mailing address
5344 TRAILVIEW DR, BLACK JACK, MO 63033-4645
(314) 309-7758
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16982862
—
MO
Enumeration date
12/08/2020
Last updated
12/08/2020
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