Provider Demographics
NPI:1578966420
Name:TOURTILLOTT, MISTY A (NP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:A
Last Name:TOURTILLOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:A
Other - Last Name:SWARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-0370
Mailing Address - Country:US
Mailing Address - Phone:660-200-7133
Mailing Address - Fax:660-200-2396
Practice Address - Street 1:617 W NURSERY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1840
Practice Address - Country:US
Practice Address - Phone:660-200-7133
Practice Address - Fax:660-200-2396
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014022533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily