Provider Demographics
NPI:1255651097
Name:OBERGOENNER, LUCIA (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:
Last Name:OBERGOENNER
Suffix:
Gender:
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 OLD TOLL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3023
Mailing Address - Country:US
Mailing Address - Phone:573-979-3892
Mailing Address - Fax:
Practice Address - Street 1:112 MAVERICK CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-1381
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2010002440363LW0102X
MO2010002440363LW0102X
TX1172658363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health