Organization Name: | FORSYTH FAMILY MEDICAL CLINIC, LLC |
NPI Number: | 1265753792 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHEILA LOUISE WYMAN (FNP / OWNER) |
Mailing Address: | 10726 E Hwy 76 Ste. G Forsyth |
State: | MO US |
Postal Code: | 65653 |
Phone Number: | 4175462590 |
Fax Number: | 4175462594 |
NPI Enumeration Date: | 06/18/2010 |
NPI Last Update Date: | 04/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 120158 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |