Healthcare Provider Details

I. General information

NPI: 1083126569
Provider Name (Legal Business Name): ANNAH C SYBOUTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 07/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S PLATTE CLAY WAY
KEARNEY MO
64060
US

IV. Provider business mailing address

305 S PLATTE CLAY WAY
KEARNEY MO
64060-8214
US

V. Phone/Fax

Practice location:
  • Phone: 816-628-4409
  • Fax:
Mailing address:
  • Phone: 816-628-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017032436
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: