=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578791919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH ANN MAGGARD FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2009
-----------------------------------------------------
Last Update Date | 04/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 NE CORONADO DR
-----------------------------------------------------
City | BLUE SPRINGS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64014-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-622-3342
-----------------------------------------------------
Fax | 816-622-3343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 NE CORONADO DR
-----------------------------------------------------
City | BLUE SPRINGS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64014-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-622-3342
-----------------------------------------------------
Fax | 816-622-3343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 53-75023-041
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2006023774
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------