| NPI | 1053742643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE A VICKERY Owner 816-500-0487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 13-87373-111) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2013-12-06 |