MEDICARE: ANGELA N STOTT PNP

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	363LP0200X	Pediatric Nurse Practitioner	2007015228	MO

General Provider Information

NPI Number	:	1871804666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA N STOTT PNP

Provider Business Mailing Address
First Line	:	1425 NW BLUE PKWY
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 SW LEMANS LN
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4618
Country	:	US
Telephone Number	:	816-525-4700
Fax Number	:	816-525-2697

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

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	04/08/2011

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