Healthcare Provider Details

I. General information

NPI: 1407053648
Provider Name (Legal Business Name): MRS. SHARON DARLENE WEIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39906 E 219TH ST
KINGSVILLE MO
64061-9279
US

IV. Provider business mailing address

39906 E 219TH ST
KINGSVILLE MO
64061-9279
US

V. Phone/Fax

Practice location:
  • Phone: 816-865-3392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number6448-9631
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: