1649830290 NPI number — MRS. STEPHANIE RENEE MCGARITY FNP

Table of content: MRS. STEPHANIE RENEE MCGARITY FNP (NPI 1649830290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649830290 NPI number — MRS. STEPHANIE RENEE MCGARITY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGARITY
Provider First Name:
STEPHANIE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARNOLD
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649830290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 802843
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64180-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-269-5712
Provider Business Mailing Address Fax Number:
417-269-7567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2240 W SUNSET ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65807-6041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-269-4663
Provider Business Practice Location Address Fax Number:
417-269-0692
Provider Enumeration Date:
06/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  2019011364 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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