Healthcare Provider Details

I. General information

NPI: 1336540897
Provider Name (Legal Business Name): STACEY ANNE ESTES- JUVE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE BLUE PKWY
LEES SUMMIT MO
64063-1007
US

IV. Provider business mailing address

75 V ST
LAKE LOTAWANA MO
64086-9766
US

V. Phone/Fax

Practice location:
  • Phone: 816-282-5251
  • Fax:
Mailing address:
  • Phone: 816-588-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number128829
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: