Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2021012472 | MO |
N | 363LA2100X | Nurse Practitioner - Acute Care | 2021012472 | MO |
N | 363LA2200X | Nurse Practitioner - Adult Health | 2021012472 | MO |
N | 363LG0600X | Nurse Practitioner - Gerontology | 2021012472 | MO |
NPI | 1073193421 |
---|---|
Provider Name | Mr. Adam Cole Ashby |
First Address | Kansas City, MO 64119-7835 |
Second Address | Kansas City, MO 64116-4321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2021 |
Last Update Date | 10/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2021012472 | STATE LICENSE (01) | MO |