Basic Information
Provider Information
NPI: 1003141144
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARTON
FirstName: YVONNE
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: BSN, RN, MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 130 CALO LN
Address2:  
City: LAKE OZARK
State: MO
PostalCode: 650499208
CountryCode: US
TelephoneNumber: 5733652221
FaxNumber: 5733652224
Practice Location
Address1: 130 CALO LN
Address2:  
City: LAKE OZARK
State: MO
PostalCode: 650499208
CountryCode: US
TelephoneNumber: 5733652221
FaxNumber: 5733652224
Other Information
ProviderEnumerationDate: 10/07/2009
LastUpdateDate: 10/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0808XR868600MSN Nursing Service ProvidersRegistered NursePsych/Mental Health
163WP0808X2009011726MOY Nursing Service ProvidersRegistered NursePsych/Mental Health

ID Information
IDTypeStateIssuerDescription
340454705NC MEDICAID


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