Healthcare Provider Details

I. General information

NPI: 1487317392
Provider Name (Legal Business Name): MARY SHEARER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW SOUTH OUTER RD STE 200
BLUE SPRINGS MO
64015-3069
US

IV. Provider business mailing address

2524 N 150TH ST
OMAHA NE
68116-5130
US

V. Phone/Fax

Practice location:
  • Phone: 888-256-3814
  • Fax:
Mailing address:
  • Phone: 402-659-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number113870
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79778
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: