Provider Demographics
NPI:1841490141
Name:FLOOD, WILBUR EARL (RN, FNP)
Entity type:Individual
Prefix:
First Name:WILBUR
Middle Name:EARL
Last Name:FLOOD
Suffix:
Gender:M
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 S RANGE LINE RD STE C
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5996
Mailing Address - Country:US
Mailing Address - Phone:417-434-9445
Mailing Address - Fax:
Practice Address - Street 1:1421 S RANGE LINE RD STE C
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5996
Practice Address - Country:US
Practice Address - Phone:417-434-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001780363LF0000X
MO104459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily