Provider Demographics
NPI:1598859688
Name:ADAMS, SALLY K (DC, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:K
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1039
Mailing Address - Country:US
Mailing Address - Phone:417-926-6111
Mailing Address - Fax:
Practice Address - Street 1:120 W 16TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1039
Practice Address - Country:US
Practice Address - Phone:417-926-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0391111NX0800X
MSR895367363LF0000X
MO2015044894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST20850Medicare UPIN