Provider Demographics
NPI:1023094240
Name:SCHRAGE, BETH M (RNCSFNP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:SCHRAGE
Suffix:
Gender:F
Credentials:RNCSFNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1416 CROWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2548
Mailing Address - Country:US
Mailing Address - Phone:660-627-5757
Mailing Address - Fax:660-627-5802
Practice Address - Street 1:100 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537-1335
Practice Address - Country:US
Practice Address - Phone:660-397-3571
Practice Address - Fax:660-397-2307
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107529363LC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO426885000Medicaid
MO261821Medicare Oscar/Certification
MOR22213Medicare UPIN
MO426885000Medicaid