Individual
PHYLLIS JOHNNA MANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
101 SKAGGS RD, SUITE 302, BRANSON, MO 65616-2075
(417) 334-8288
(417) 334-6966
Mailing address
101 SKAGGS RD, SUITE 302, BRANSON, MO 65616-2075
(417) 334-8288
(417) 334-6966
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2009013387
MO
Other
Enumeration date
06/03/2009
Last updated
10/17/2019
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