| Nicole Ruopp, | |
|
2432 E Main St, Jackson, MO 63755-2487 | |
| (573) 755-2305 | |
| Not Available |
| Full Name | Nicole Ruopp |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 2432 E Main St, Jackson, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750910873 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 2021032539 (Missouri) | Primary |
| Entity Name | Southeast Missouri Hospital Physicians LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558311522 PECOS PAC ID: 9133024334 Enrollment ID: O20031201000775 |
| Entity Name | Mercy Clinic East Communities |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1851335228 PECOS PAC ID: 7214827922 Enrollment ID: O20070521000006 |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Ruopp, 11001 Sandistan Dr, Saint Louis, MO 63146-5584 Ph: (763) 464-7344 | Nicole Ruopp, 2432 E Main St, Jackson, MO 63755-2487 Ph: (573) 755-2305 |
Ms. Marcy A Emmons, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2130 E Jackson Blvd, Jackson, MO 63755 Phone: 573-243-8408 Fax: 573-243-0445 |
Jessie Lee Kibbe, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2432 E Main St, Jackson, MO 63755 Phone: 573-755-2305 Fax: 800-800-5123 |