Provider Demographics
NPI:1326050659
Name:BROTHERS, BETH ANN (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:BROTHERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FAMILY NURSE PRACTIT
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:6500 HOSPITAL DRIVE
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1239
Mailing Address - Country:US
Mailing Address - Phone:573-629-3440
Mailing Address - Fax:573-629-3423
Practice Address - Street 1:6500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6890
Practice Address - Country:US
Practice Address - Phone:573-629-3440
Practice Address - Fax:573-629-3423
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO077469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000082822Medicare ID - Type Unspecified