Provider Demographics
NPI:1518501220
Name:CONTI, MARY ARTINA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ARTINA
Last Name:CONTI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ARTINA
Other - Last Name:HUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 9007 COX HEALTH
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808
Mailing Address - Country:US
Mailing Address - Phone:417-875-2621
Mailing Address - Fax:
Practice Address - Street 1:3800 S NATIONAL AVE, SUITE 400 WHEELER HEART AND VASCUL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-875-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016024417163WX0200X
MO2020004166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420080598Medicaid