Healthcare Provider Details

I. General information

NPI: 1083024863
Provider Name (Legal Business Name): KATHRYN MAGERS R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S. GREEN ST
LANCASTER MO
63548
US

IV. Provider business mailing address

PO BOX 387 213 S. GREEN ST
LANCASTER MO
63548
US

V. Phone/Fax

Practice location:
  • Phone: 660-457-3721
  • Fax: 660-457-2238
Mailing address:
  • Phone: 660-457-3721
  • Fax: 660-457-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number2011000651
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: