Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 343607 | MO |
NPI | 1275155533 |
---|---|
Provider Name | Kevin Painter |
First Address | Springfield, MO 65804-2203 |
Second Address | Springfield, MO 65804-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2020 |
Last Update Date | 10/05/2020 |