Provider Demographics
NPI:1922001569
Name:HITT, SHIRLEY MAE (FNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MAE
Last Name:HITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:STE G51
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3070
Mailing Address - Country:US
Mailing Address - Phone:573-458-6010
Mailing Address - Fax:573-458-6060
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:STE G51
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3070
Practice Address - Country:US
Practice Address - Phone:573-458-6010
Practice Address - Fax:573-458-6060
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN-062822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS30883Medicare UPIN