Healthcare Provider Details

I. General information

NPI: 1851417646
Provider Name (Legal Business Name): LISA A DOVE RN, CS, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

IV. Provider business mailing address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-6818
  • Fax:
Mailing address:
  • Phone: 816-307-4893
  • Fax: 816-232-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number118517
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: