| Mt.vernon Clinic | |
|
1011 S East St Mount Vernon MO 65712-1331 | |
| (417) 466-7191 | |
| (417) 466-3876 |
| Full Name | Mt.vernon Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1011 S East St, Mount Vernon, Missouri |
| Authorized Official Name and Position | Robert Williams (OFFICE MANAGER) |
| Authorized Official Contact | 4174667191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mt.vernon Clinic 1011 S East St Mount Vernon MO 65712-1399 Ph: (417) 466-7191 | Mt.vernon Clinic 1011 S East St Mount Vernon MO 65712-1331 Ph: (417) 466-7191 |
| NPI Number | 1649332156 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 01/06/2026 |
| Certification Date | 01/06/2026 |
| Medicare PECOS PAC ID | 1951353192 |
|---|---|
| Medicare Enrollment ID | O20050215001046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649332156 | NPI | - | NPPES |
| 590665907 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 261QR1300X | Clinic/center - Rural Health | 113916 (Missouri) | Primary |
| Provider Name | Cheryl L Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730187204 PECOS PAC ID: 7315978236 Enrollment ID: I20051215000092 |
| Provider Name | Amy Eileen Moenning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174203939 PECOS PAC ID: 3678937463 Enrollment ID: I20230912003988 |
| Provider Name | Kendra Bowles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598536575 PECOS PAC ID: 5597273896 Enrollment ID: I20250806000944 |
| Provider Name | Stephanie B Justus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629452107 PECOS PAC ID: 6406158435 Enrollment ID: I20251205000921 |
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