Provider Demographics
NPI:1235280678
Name:CARSON, PATRICIA A (CNS/ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CARSON
Suffix:
Gender:F
Credentials:CNS/ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 PORTER WAGONER BLVD # 23
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1826
Mailing Address - Country:US
Mailing Address - Phone:417-257-6762
Mailing Address - Fax:417-257-5875
Practice Address - Street 1:1211 PORTER WAGONER BLVD # 23
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1826
Practice Address - Country:US
Practice Address - Phone:417-257-6762
Practice Address - Fax:417-257-5875
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74150363L00000X
MO131048363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100456320AMedicaid
AR81863Medicaid
MO1235280678Medicaid
KS100456320AMedicaid
MO1235280678Medicaid