Provider Demographics
NPI:1255765822
Name:HUSTON, BERNADETTE ROSE
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ROSE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:ROSE
Other - Last Name:SAMSON HUSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNS
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:28 S MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4914
Practice Address - Country:US
Practice Address - Phone:573-331-3350
Practice Address - Fax:573-331-3351
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013005397364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health