Provider Demographics
NPI:1265781850
Name:COUNTS, DESIREA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:DESIREA
Middle Name:LYNN
Last Name:COUNTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 62 BOX 285
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-8807
Mailing Address - Country:US
Mailing Address - Phone:573-247-1611
Mailing Address - Fax:
Practice Address - Street 1:HC 62 BOX 285
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-8807
Practice Address - Country:US
Practice Address - Phone:573-247-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009028288164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse