MEDICARE: DEBRA C. PANKAU FNP

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	103547	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710955406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA C. PANKAU FNP

Provider Business Mailing Address
First Line	:	2303 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4954
Country	:	US
Telephone Number	:	816-232-6818
Fax Number	:	816-232-2991

Provider Business Practice Location Address
First Line	:	305 RHODE ISLAND
Second Line	:
City	:	KING CITY
State	:	MO
Zip	:	64463-0278
Country	:	US
Telephone Number	:	660-535-4347
Fax Number	:	660-535-6240

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	11/10/2021

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