Healthcare Provider Details

I. General information

NPI: 1679052260
Provider Name (Legal Business Name): HILARY B SHOEMAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SAINT JOSEPH AVE
SAINT JOSEPH MO
64505
US

IV. Provider business mailing address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-3338
  • Fax:
Mailing address:
  • Phone: 816-307-4893
  • Fax: 816-232-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013002465
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018030494
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: