MEDICARE: RENEE ENDICOTT F.N.P

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	363L00000X	Nurse Practitioner	094920	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689664690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ENDICOTT F.N.P

Provider Business Mailing Address
First Line	:	PO BOX 92
Second Line	:
City	:	HARRISONVILLE
State	:	MO
Zip	:	64701-0092
Country	:	US
Telephone Number	:	816-590-4907
Fax Number	:

Provider Business Practice Location Address
First Line	:	2464 CHARLOTTE ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2718
Country	:	US
Telephone Number	:	816-590-4907
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	05/24/2010

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