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General NPI Number Information
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NPI Number | 1306429568
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Entity Type | Individual
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Provider Name | CODY SHOPPER
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Gender | Male
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 2301 HOLMES ST
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City | KANSAS CITY
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State | MO
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Zip | 64108-2640
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Country | US
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Telephone | 816-404-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 MARTIN LUTHER KING DRIVE APT A
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 816-365-1727
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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