Provider Demographics
NPI:1588732903
Name:DULWORTH, STARLA KAY (RN, MSN, BC, FNP)
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:KAY
Last Name:DULWORTH
Suffix:
Gender:F
Credentials:RN, MSN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 B VARVARA ROAD
Mailing Address - Street 2:
Mailing Address - City:DOE RUN
Mailing Address - State:MO
Mailing Address - Zip Code:63637
Mailing Address - Country:US
Mailing Address - Phone:573-760-0674
Mailing Address - Fax:573-783-1096
Practice Address - Street 1:735 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1113
Practice Address - Country:US
Practice Address - Phone:573-783-8875
Practice Address - Fax:573-783-8890
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
268942OtherMEDICARE RHC
MO597560408Medicaid
MOQ07477Medicare UPIN