Healthcare Provider Details

I. General information

NPI: 1780090860
Provider Name (Legal Business Name): PEDIATRIC CARE NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8781 N PLATTE PURCHASE DR
KANSAS CITY MO
64155-1829
US

IV. Provider business mailing address

8781 N PLATTE PURCHASE DR
KANSAS CITY MO
64155-1829
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-3200
  • Fax: 816-587-7644
Mailing address:
  • Phone: 816-587-3200
  • Fax: 816-587-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2012029116
License Number StateMO

VIII. Authorized Official

Name: SUSAN L STORM
Title or Position: PRESIDENT
Credential: MD
Phone: 816-587-3200