Provider Demographics
NPI:1659843530
Name:ADKISSON, CARY DEAN (FNP)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:DEAN
Last Name:ADKISSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1705 E BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7167
Mailing Address - Country:US
Mailing Address - Phone:573-874-8700
Mailing Address - Fax:573-607-3878
Practice Address - Street 1:105 N KEENE ST STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8131
Practice Address - Country:US
Practice Address - Phone:573-499-4990
Practice Address - Fax:573-442-2120
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2025-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2018044469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily