Provider Demographics
NPI:1639565823
Name:FLEETWOOD, LAURA C (ANP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:1229 E SEMINOLE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2227
Mailing Address - Country:US
Mailing Address - Phone:417-820-5150
Mailing Address - Fax:
Practice Address - Street 1:1229 E SEMINOLE ST STE 220
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2227
Practice Address - Country:US
Practice Address - Phone:417-820-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015011087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639565823Medicaid
MO1639565823Medicaid