Provider Demographics
NPI:1336688829
Name:DUKES, CONNIE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:DUKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S. LIMIT AVE.
Mailing Address - Street 2:STE. #5
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301
Mailing Address - Country:US
Mailing Address - Phone:660-829-4299
Mailing Address - Fax:
Practice Address - Street 1:1400 S LIMIT AVE
Practice Address - Street 2:STE. #5
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5118
Practice Address - Country:US
Practice Address - Phone:660-829-4299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003000257173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist