Provider Demographics
NPI:1811902638
Name:CARNETT, SHEILA A (DO)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:CARNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5227
Mailing Address - Country:US
Mailing Address - Phone:573-632-5510
Mailing Address - Fax:573-632-5810
Practice Address - Street 1:1125 MADISON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5227
Practice Address - Country:US
Practice Address - Phone:573-632-5510
Practice Address - Fax:573-632-5810
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4009207V00000X
MO2008023312207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1811902638Medicaid
OK200104990AMedicaid
MOP00696338OtherRR MEDICARE
OK200104990AMedicaid
OKOK400177Medicare PIN
MOP00696338OtherRR MEDICARE