ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE (NPI# 1962859090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962859090 |
| Entity Type | Organization |
| Organization Name | ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE |
| Practice Address |
4525 Downs Dr Blum Union Room 203 Saint Joseph MO 64507-2246 |
| Practice Telephone | 8162714495 |
| Practice Fax Number | 8162714496 |
| Mailing Telephone | 8162714495 |
| Mailing Fax Number | 8162714496 |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-05-18 |
| Authorized Official Name | ELIZABETH RODERICK (NURSE PRACTICTIONER) |
| Authorized Official Telephone | 8162714495 |
| Authorized Official Credential | FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
138383 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | NP TYPE I NPI | 1801099874 | 01 |
| Street Address |
4525 DOWNS DR BLUM UNION ROOM 203 |
| City | SAINT JOSEPH |
| State | MO |
| Zip Code | 64507-2246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174860944 | Blaise D. Kriley | Specialist/Technologist | 4525 Downs Dr, Saint Joseph, MO 64507-2246 | 2013-01-13 |
| 1033696018 | Devon Schmitz | Specialist/Technologist | 4525 Downs Dr, Saint Joseph, MO 64507-2246 | 2018-07-23 |
| 1891214318 | Robert Vetter | Specialist/Technologist | 4525 Downs Dr, Saint Joseph, MO 64507-2246 | 2017-09-15 |
| 1518404557 | Cody Derby | Specialist/Technologist | 4525 Downs Dr, Attn: Sports Medicine, Saint Joseph, MO 64507-2246 | 2017-01-29 |
| 1821541269 | Kathryn Spear | Specialist/Technologist | 4525 Downs Dr, Saint Joseph, MO 64507-2246 | 2016-08-02 |
| 1063891158 | Missouri Western State University | Orthopaedic Surgery | 4525 Downs Dr, Saint Joseph, MO 64507-2246 | 2015-05-22 |
| 1235539586 | Logan Eck | Specialist/Technologist | 4525 Downs Dr, Saint Joseph, MO 64507-2246 | 2014-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346644044 | Janaha Anderson | Dental Hygienist | 4073 Se Cunningham Rd, St. Joseph, MO 64507 | 2014-10-09 |
| 1518229772 | Andrew L Walker | Radiology | 902 N Riverside Rd Ste 201, Saint Joseph, MO 64507 | 2012-06-13 |
| 1619105731 | Pamela M. Lotz | Clinical Nurse Specialist | 902 No. Riverside Rd, Suite 200, St. Joseph, MO 64507 | 2009-06-26 |
| 1356300735 | St Joseph Oncology Inc | Internal Medicine | 902 No Riverside Rd, Suite 200, St Joseph, MO 64507 | 2006-03-22 |
| 1962478560 | Douglas Chyatte | Neurological Surgery | 802 N Riverside Rd Ste 120, Saint Joseph, MO 64507 | 2006-02-24 |
| 1073089546 | Chaz Caleb Johnson | Physical Therapist | 5506 Corporate Dr Ste 1800, Saint Joseph, MO 64507 | 2018-10-22 |
| 1295228344 | Julie Odonnell Phd LLC | Clinic/Center | 708 S Woodbine Rd Ste A, Saint Joseph, MO 64507 | 2018-06-13 |
| 1912369695 | Luke Nathan Prest | Pediatrics | 902 N Riverside Rd Ste 100, Saint Joseph, MO 64507 | 2016-03-22 |
| 1396007894 | Brian Wright Roe | Internal Medicine | 5514 Corporate Dr Ste 150, Saint Joseph, MO 64507 | 2012-06-11 |
| 1861873952 | Edison Derr II | Specialist/Technologist | 2214 Maple St, Saint Joseph, MO 64507-1413 | 2015-06-15 |
| Find all providers in zip 64507 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790399681 | Aryn Fidler | Nurse Practitioner | 2212 Shamrock Ln, Saint Joseph, MO 64505-1158 | 2020-09-08 |
| 1306323316 | Camilla Allison Walling | Nurse Practitioner | 1009 West St. Maartens Drive Suite F, Saint Joseph, MO 64506 | 2018-07-23 |
| 1326578600 | Caitlin Copes | Nurse Practitioner | 402 Levee Rd, Saint Joseph, LA 71366-6661 | 2017-06-19 |
| 1013452325 | Teresa Lynn Mead-hahn | Nurse Practitioner | 2922 Angelique St, Saint Joseph, MO 64501-3437 | 2016-12-21 |
| 1922426519 | Julie Turner | Nurse Practitioner | 3502 N 7th St, Saint Joseph, MO 64505-2937 | 2014-04-01 |
| 1235552977 | Ronda Sue Damgar | Nurse Practitioner | 802 N Riverside Rd Ste 200, Saint Joseph, MO 64507-2553 | 2014-01-31 |
| 1629356142 | Image Specialties, L.L.C. | Nurse Practitioner | 5213 Frederick Ave, Saint Joseph, MO 64506-3263 | 2011-08-01 |
| 1629362645 | Elizabeth Ann Sullivan | Nurse Practitioner | 3915 Sherman Ave, Saint Joseph, MO 64506-3649 | 2011-06-07 |
| 1497051171 | Linda Louise Gerhardt | Nurse Practitioner | 5210 Belt Highway, Saint Joseph, MO 64506-1211 | 2011-01-28 |
| 1124343074 | Jayna J. Monical | Nurse Practitioner | 1510 Duncan St, Saint Joseph, MO 64503-2600 | 2010-04-05 |
| Find all providers in SAINT JOSEPH | ||||
| City | SAINT JOSEPH |
| Zip Code | 64507 |
Please comment or provide details below to improve the information on ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.