Provider Demographics
NPI:1356832653
Name:MOBILE HEALTH PRACTITIONERS LLC
Entity Type:Organization
Organization Name:MOBILE HEALTH PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:VAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:314-488-3464
Mailing Address - Street 1:1078 EAGLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1257
Mailing Address - Country:US
Mailing Address - Phone:314-488-3464
Mailing Address - Fax:
Practice Address - Street 1:1078 EAGLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1257
Practice Address - Country:US
Practice Address - Phone:314-488-3464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care