Organization
COMMUNITY HOSPITAL ASSOCIATION FNP GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE JONES (ADMINISTRATOR)
(660) 686-2211
Entity
Organization
Contact information
Practice address
26136 US HIGHWAY 59, FAIRFAX, MO 64446-9105
(660) 686-2211
Mailing address
405 E MAIN ST, PO BOX 107, FAIRFAX, MO 64446-8155
(660) 686-2211
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
102-48
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00594011
BCBS
MO
05
—
540492501
—
MO
Enumeration date
02/14/2007
Last updated
10/21/2019
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