Individual provider Active NPI

Myesha Prater

  • Case Manager/Care Coordinator
  • Poplar Bluff, MO
National Provider Identifier
1972953206
Registry record updated Jun 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
License
T980069213 Issued in MO
Practice address
3001 Warrior LN
Poplar Bluff, MO 63901-8685
Phone
(573) 686-1200
NPI assigned
Jun 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X T980069213 MO Primary

Addresses

Primary practice location

3001 Warrior LN
Poplar Bluff, MO 63901-8685

Mailing address

1509 S 11TH St
Poplar Bluff, MO 63901-6429
Phone (573) 714-8407

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
T980069213MOMDCase Manager/Care Coordinator

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466121600000",
    "number": "1972953206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 S 11TH ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639016429",
            "telephone_number": "573-714-8407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 WARRIOR LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018685",
            "telephone_number": "573-686-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATER",
        "first_name": "MYESHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-17",
        "last_updated": "2016-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "MO",
            "license": "T980069213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.