Basic Information
| Provider Information | |||||||||
| NPI: | 1518961267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADCOCK | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | RN, MSN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2519 COURTNEY PL | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657754402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172577305 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 805 KENTUCKY AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172562111 | ||||||||
| FaxNumber: | 4172564858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 363LF0000X | RN117506 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 599022308 | 05 | MO | MEDICAID | 599022307 | 05 | MO | MEDICAID | 425685617 | 05 | MO | MEDICAID |