MEDICARE: MRS. STACIE L BOHN 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	AP120816	TX
2	363L00000X	Nurse Practitioner	2021035610	MO

General Provider Information

NPI Number	:	1568651024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACIE L BOHN FNP-C

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 EAST MEYER BLVD, 1 WEST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-6413
Country	:	US
Telephone Number	:	816-276-4700
Fax Number	:	281-351-2803

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	05/08/2024

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