Healthcare Provider Details

I. General information

NPI: 1821360488
Provider Name (Legal Business Name): STEPHEN S MOYER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2012
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

PO BOX 411851
KANSAS CITY MO
64141-1851
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6670
  • Fax: 913-588-3365
Mailing address:
  • Phone: 913-588-6670
  • Fax: 913-588-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number53-75603-031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: