Provider Demographics
NPI:1316486202
Name:ADAMS, VANESSA (NP-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-0699
Mailing Address - Country:US
Mailing Address - Phone:573-686-4750
Mailing Address - Fax:573-686-4753
Practice Address - Street 1:225 PHYSICIANS PARK
Practice Address - Street 2:STE 203
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3935
Practice Address - Country:US
Practice Address - Phone:573-686-4750
Practice Address - Fax:573-686-4753
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017003057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily