Basic Information
| Provider Information | |||||||||
| NPI: | 1558640334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROCTOR | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1416 OO HWY | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640766440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165653384 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1278 OLD US 40 HWY | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166335921 | ||||||||
| FaxNumber: | 8166337942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2011 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2000146034 | MO | Y | Nursing Service Providers | Registered Nurse |
No ID Information.