MEDICARE: MS. CYNTHIA DIANE STOCK FNP-C

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	2016006905	MO

General Provider Information

NPI Number	:	1669843793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA DIANE STOCK FNP-C

Provider Business Mailing Address
First Line	:	825 S BUSINESS HIGHWAY 13
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1515
Country	:	US
Telephone Number	:	660-259-2440
Fax Number	:	660-251-0524

Provider Business Practice Location Address
First Line	:	608 MISSOURI ST
Second Line	:
City	:	WAVERLY
State	:	MO
Zip	:	64096
Country	:	US
Telephone Number	:	660-493-2262
Fax Number	:

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

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	09/11/2018

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