Doctor Name: | MR. PHILLIP R CUMMINGS |
NPI Number: | 1255324828 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RN,BC,FNP |
License Number: | 057081 |
Business Practice Address: | 12 Jefferson Sq De Soto, MO - 630201031 |
Business Phone Number: | 6365866685 |
Business Fax Number: | 6365862780 |
Mailing Address: | 12 Jefferson Sq, DE SOTO |
State: | MO |
Postal Code: | 630201031 |
Phone Number: | 6365866685 |
Fax Number: | 6365862780 |
NPI Enumeration Date: | 08/29/2005 |
NPI Last Update Date: | 12/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 057081 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |