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Contact Information

VIVIAN DUDLEY
125 N OLD HWY 66
BOURBON, MO65441
 Phone: 573-679-2006
 Fax: 573-679-2009
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for VIVIAN DUDLEY · (Female)

NPI Number 1013018654
Status Active
Credentials
Entity Individual
Enumeration date 09/26/2006
Last updated 08/25/2014 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 142760
  • MO Medicaid 1013018654
  • MO Medicaid 425076205
  • MO Other P01134574 RAILROAD MEDICARE
Hospital affiliation(s)
  • MERCY HOSPITAL WASHINGTON - (Acute Care)
    901 EAST 5TH STREET
    WASHINGTON, MO 63090
  • PHELPS COUNTY REGIONAL MEDICAL CENTER - (Acute Care)
    1000 W 10TH ST
    ROLLA, MO 65401
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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