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General NPI Number Information
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NPI Number | 1063925022
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Entity Type | Individual
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Provider Name | SHANNON GLYNN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 1914 SWIFT AVE
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-3447
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Country | US
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Telephone | 816-221-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 9904 MERCIER ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-4257
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Country | US
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Telephone | 816-510-8022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2017040108
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License Number State | MO
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