Provider Demographics
NPI:1356369714
Name:CONSTANT, CAROL J (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:CONSTANT
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-0316
Mailing Address - Country:US
Mailing Address - Phone:660-646-0011
Mailing Address - Fax:
Practice Address - Street 1:103 11TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1676
Practice Address - Country:US
Practice Address - Phone:660-646-6411
Practice Address - Fax:660-646-5881
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO99778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428401814Medicaid
Q17166Medicare UPIN
776D742BMedicare ID - Type Unspecified
MOMA1521009Medicare PIN