Basic Information
| Provider Information | |||||||||
| NPI: | 1003141144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARTON | ||||||||
| FirstName: | YVONNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BSN, RN, MA | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 2009011726 | MO | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0808X | R868600 | MS | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 3404547 | 05 | NC | MEDICAID |