Provider Demographics
NPI:1821519430
Name:GEORGE, SUMMER WARREN (FNP-C)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:WARREN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:WARREN
Other - Last Name:CARGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:603 S BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4314
Mailing Address - Country:US
Mailing Address - Phone:573-458-8899
Mailing Address - Fax:
Practice Address - Street 1:603 S BISHOP AVE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4320
Practice Address - Country:US
Practice Address - Phone:573-426-4411
Practice Address - Fax:573-426-4403
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-213351363LF0000X
TXAP134323363LF0000X
MO2024028755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily