MEDICARE: LAURA STOCKAMP FNP, 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	363LF0000X	Family Nurse Practitioner	2016009393	MO

General Provider Information

NPI Number	:	1457713687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA STOCKAMP FNP, C

Provider Business Mailing Address
First Line	:	724 SW TISHA LN
Second Line	:
City	:	GRAIN VALLEY
State	:	MO
Zip	:	64029-8010
Country	:	US
Telephone Number	:	816-301-2399
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 WORNALL RD STE 50
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5943
Country	:	US
Telephone Number	:	816-931-3312
Fax Number	:	816-531-9862

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

Provider Enumeration Date	:	03/26/2016
Last Update Date	:	03/26/2016

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