MEDICARE: SHANNON GLYNN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2017040108	MO

General Provider Information

NPI Number	:	1063925022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON GLYNN

Provider Business Mailing Address
First Line	:	9904 MERCIER ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4257
Country	:	US
Telephone Number	:	816-510-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3447
Country	:	US
Telephone Number	:	816-221-1603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	11/13/2017

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Directions to “ SHANNON GLYNN ” Practice Location

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