Provider Demographics
NPI:1194966713
Name:CUMLEY, BECKY A (NP-C)
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:A
Last Name:CUMLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:PEABODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:2900A S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3634
Practice Address - Country:US
Practice Address - Phone:417-269-9530
Practice Address - Fax:417-269-9539
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO131708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
MOPENDINGMedicare PIN