Healthcare Provider Details

I. General information

NPI: 1154979938
Provider Name (Legal Business Name): GREG L TESTERMAN ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 LITTLE BLUE PARKWAY SUITE 300
INDEPENDENCE MO
64057
US

IV. Provider business mailing address

4200 LITTLE BLUE PARKWAY SUITE 300
INDEPENDENCE MO
64057
US

V. Phone/Fax

Practice location:
  • Phone: 816-353-2700
  • Fax: 816-795-7311
Mailing address:
  • Phone: 816-353-2700
  • Fax: 816-795-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2004024273
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2004024273
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2019032538
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: