| NPI | 1205154606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL JEAN JACKSON Office Manager 816-732-6010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: MO 076670) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 076670) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2015-04-10 |