Provider Demographics
NPI:1871716456
Name:ADKISSON, LINDA G (APRN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:G
Last Name:ADKISSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:G
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1121 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7708
Mailing Address - Country:US
Mailing Address - Phone:573-335-7846
Mailing Address - Fax:
Practice Address - Street 1:1121 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7708
Practice Address - Country:US
Practice Address - Phone:573-335-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100492OtherRN LICENSE
MO1871716456Medicaid
MO1871716456OtherNPI