Provider Demographics
NPI:1073519773
Name:CARRON, JANELLE S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:S
Last Name:CARRON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 N HIGHWAY 47
Mailing Address - Street 2:STE B
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1108
Mailing Address - Country:US
Mailing Address - Phone:636-456-3413
Mailing Address - Fax:636-456-7238
Practice Address - Street 1:722 N HIGHWAY 47
Practice Address - Street 2:STE B
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1108
Practice Address - Country:US
Practice Address - Phone:636-456-3413
Practice Address - Fax:636-456-7238
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO086277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429029309Medicaid
MOS97407Medicare UPIN
MO429029309Medicaid