MEDICARE: NICHOLAS MAXWELL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2018021515	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2018021515	OTHER	MO	MISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS

General Provider Information

NPI Number	:	1194211144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MAXWELL PA-C

Provider Business Mailing Address
First Line	:	15940 COUNTRY LN W
Second Line	:
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-9524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 N OAK TRFY STE 201
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4600
Country	:	US
Telephone Number	:	816-454-0666
Fax Number	:	816-559-7118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	05/15/2023

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Directions to “ NICHOLAS MAXWELL PA-C” Practice Location

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