Provider Demographics
NPI:1427465194
Name:CURLESS, CAROL D (FNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:D
Last Name:CURLESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:D
Other - Last Name:KRAMME-CURLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3817 S SPRINGFIELD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-9129
Mailing Address - Country:US
Mailing Address - Phone:417-730-3508
Mailing Address - Fax:
Practice Address - Street 1:3817 S SPRINGFIELD AVE STE 120
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-9129
Practice Address - Country:US
Practice Address - Phone:417-730-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000163053363LF0000X
MO2014019279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
MOPENDINGMedicare PIN