Organization Name: | EXCELSIOR SPRINGS PEDIATRIC CLINIC |
NPI Number: | 1568750420 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLI L BOWMAN (OFFICE MANAGER) |
Mailing Address: | 1006 N Jesse James Rd Ste 2 Excelsior Springs |
State: | MO US |
Postal Code: | 640241202 |
Phone Number: | 8166370117 |
Fax Number: | 8166370814 |
NPI Enumeration Date: | 07/13/2011 |
NPI Last Update Date: | 07/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2011006205 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |