Healthcare Provider Details

I. General information

NPI: 1922104447
Provider Name (Legal Business Name): ELAINE K AKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S BROADWAY BOX 670
OAK GROVE MO
64075
US

IV. Provider business mailing address

1900 S BROADWAY BOX 670
OAK GROVE MO
64075
US

V. Phone/Fax

Practice location:
  • Phone: 816-690-6566
  • Fax: 816-625-8276
Mailing address:
  • Phone: 816-690-6566
  • Fax: 816-625-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number059535
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: