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General NPI Number Information
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NPI Number | 1720183346
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Entity Type | Organization
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Legal Business Name | SHOAL CREEK FAMILY MEDICINE AND ALLERGY, PC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 S PLATTE CLAY WAY SUITE B
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City | KEARNEY
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State | MO
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Zip | 64060-8214
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Country | US
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Telephone | 816-903-8880
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Fax | 816-903-8884
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Provider Business Mailing Address
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Address Line | 301 S PLATTE CLAY WAY SUITE B
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City | KEARNEY
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State | MO
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Zip | 64060-8214
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Country | US
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Telephone | 816-903-8880
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Fax | 816-903-8884
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Authorized Official
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Title or Position | PHYSICIAN CO-OWNER
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Name | MRS. ANGELA K STAPLETON
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Credential | MD
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Telephone | 816-903-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 113071
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License Number State | MO
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