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NPI Code Detail

MEDICARE: SHANNON S MCINTOSH CPNP

MEDICARE: SHANNON S MCINTOSH CPNP
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
1363LP0200XPediatric Nurse Practitioner153357MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000645OTHERFAMILY HEALTH PARTNERS
2045847OTHERFAMILY HEALTH PARTNERS

General Provider Information

NPI Number : 1326046806
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON S MCINTOSH CPNP
Provider Business Mailing Address
First Line : 205 W R D MIZE RD
Second Line : SUITE 304
City : BLUE SPRINGS
State : MO
Zip : 64014-2518
Country : US
Telephone Number : 816-655-0125
Fax Number : 816-228-1156
Provider Business Practice Location Address
First Line : 205 W R D MIZE RD
Second Line : SUITE 304
City : BLUE SPRINGS
State : MO
Zip : 64014-2518
Country : US
Telephone Number : 816-655-0125
Fax Number : 816-228-1156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 07/08/2007

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Directions to “ SHANNON S MCINTOSH CPNP” Practice Location

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