Provider Demographics
NPI:1518961267
Name:ADCOCK, CHRISTINE HELEN (RN, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:HELEN
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 COURTNEY PL
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4402
Mailing Address - Country:US
Mailing Address - Phone:417-257-7305
Mailing Address - Fax:
Practice Address - Street 1:805 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775
Practice Address - Country:US
Practice Address - Phone:417-256-2111
Practice Address - Fax:417-256-4858
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN117506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO599022308Medicaid
MO599022307Medicaid
MO425685617Medicaid
MOP00565Medicare UPIN
MO599022307Medicaid
MO425685617Medicaid
MO000014537Medicare ID - Type UnspecifiedCARE PROFESSIONAL