Healthcare Provider Details

I. General information

NPI: 1447583869
Provider Name (Legal Business Name): LARRY MOYER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7861 SE FREEWAY FARMS DR
HOLT MO
64048-8404
US

IV. Provider business mailing address

7861 SE FREEWAY FARMS DR
HOLT MO
64048-8404
US

V. Phone/Fax

Practice location:
  • Phone: 816-588-2897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2007023704
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-104413-111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: