Provider Demographics
NPI:1043966724
Name:THURMAN, STEPHANIE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:THURMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16699 OAK HILL DRIVE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2503
Mailing Address - Country:US
Mailing Address - Phone:417-217-2458
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689-8104
Practice Address - Country:US
Practice Address - Phone:417-962-3015
Practice Address - Fax:417-962-5240
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022006055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420116989Medicaid
MO26D0679044OtherCLIA
MO26D0859759OtherCLIA