Provider Demographics
NPI:1558640334
Name:PROCTOR, LINDA LOU (RN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOU
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 OO HWY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-6440
Mailing Address - Country:US
Mailing Address - Phone:816-565-3384
Mailing Address - Fax:
Practice Address - Street 1:1278 OLD US 40 HWY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076
Practice Address - Country:US
Practice Address - Phone:816-633-5921
Practice Address - Fax:816-633-7942
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000146034163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse