Provider Demographics
NPI:1992730303
Name:FENSTERMACHER, KAREN A (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:FENSTERMACHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 LUSK DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8855
Mailing Address - Country:US
Mailing Address - Phone:417-451-2060
Mailing Address - Fax:417-451-6214
Practice Address - Street 1:2550 LUSK DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-8855
Practice Address - Country:US
Practice Address - Phone:417-451-2060
Practice Address - Fax:417-451-6214
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO073207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428635809Medicaid
MOMA5102005Medicare PIN
MO428635809Medicaid