Basic Information
| Provider Information | |||||||||
| NPI: | 1609175926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURKDOGAN | ||||||||
| FirstName: | CHARMAINE | ||||||||
| MiddleName: | CARPIZ | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARPIZ | ||||||||
| OtherFirstName: | CHARMAINE | ||||||||
| OtherMiddleName: | GONZAGA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 190 INDUSTRIAL DR | ||||||||
| Address2: | |||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630284133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6367772245 | ||||||||
| FaxNumber: | 6367772208 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 SOUTH BYP | ||||||||
| Address2: | |||||||||
| City: | KENNETT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638573244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738880030 | ||||||||
| FaxNumber: | 5738880040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2011 | ||||||||
| LastUpdateDate: | 11/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 336269 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2010042072 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 2010042072 | MO | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1609175926 | 05 | MO | MEDICAID | 013528700 | 05 | FL | MEDICAID |