Provider Demographics
NPI:1013064898
Name:BOUSE, PATRICIA KAY (RNC WHNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KAY
Last Name:BOUSE
Suffix:
Gender:F
Credentials:RNC WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SE 100TH RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-9442
Mailing Address - Country:US
Mailing Address - Phone:660-885-3491
Mailing Address - Fax:
Practice Address - Street 1:106 W 4TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1402
Practice Address - Country:US
Practice Address - Phone:660-476-2194
Practice Address - Fax:660-476-9241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO059306363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO29823019PIN 29824017Medicaid
MO070058Medicaid