Healthcare Provider Details

I. General information

NPI: 1417414178
Provider Name (Legal Business Name): ALLISON ALLSBURY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON GORDY

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 E 350
RAYTOWN MO
64133-6509
US

IV. Provider business mailing address

PO BOX 504938
SAINT LOUIS MO
63150-4938
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5700
  • Fax: 816-251-5701
Mailing address:
  • Phone: 816-599-9499
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019012586
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: