Healthcare Provider Details

I. General information

NPI: 1467839845
Provider Name (Legal Business Name): NICOLE O'HARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE DENEAN NAYLOR APRN

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N RIVERSIDE RD STE G50
SAINT JOSEPH MO
64507-2510
US

IV. Provider business mailing address

5301 FARAON ST STE 120
SAINT JOSEPH MO
64506-3512
US

V. Phone/Fax

Practice location:
  • Phone: 816-671-4888
  • Fax: 816-671-4890
Mailing address:
  • Phone: 816-671-4888
  • Fax: 816-671-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015003911
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: