Healthcare Provider Details

I. General information

NPI: 1275243487
Provider Name (Legal Business Name): NELLIE LYNN MCCUNE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 03/30/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21276 SW SHUMWAY RD
DOUGLASS KS
67039-8257
US

IV. Provider business mailing address

21276 SW SHUMWAY RD
DOUGLASS KS
67039-8257
US

V. Phone/Fax

Practice location:
  • Phone: 316-619-5343
  • Fax:
Mailing address:
  • Phone: 316-619-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number53-81750-041
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-149076-041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: