Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 2011009484 | MO |
N | 363L00000X | Nurse Practitioner | 5375392021 | KS |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2011009484 | MO |
NPI | 1013209188 |
---|---|
Provider Name | Mary Lynn Martin |
First Address | Kansas City, MO 64111-2767 |
Second Address | Kansas City, MO 64111-2767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2011 |
Last Update Date | 28/05/2021 |