1922540095 NPI number — DR. CYNTHIA SUSAN MEHRER PMHNP-BC

Table of content: DR. CYNTHIA SUSAN MEHRER PMHNP-BC (NPI 1922540095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922540095 NPI number — DR. CYNTHIA SUSAN MEHRER PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHRER
Provider First Name:
CYNTHIA
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922540095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 KELLEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEXICO
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65265-3811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-582-1234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
581 COMMONS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65251-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-642-3215
Provider Business Practice Location Address Fax Number:
573-642-7031
Provider Enumeration Date:
11/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  2016037723 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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