Individual
NICHOLAS MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5330 N OAK TRFY STE 201, KANSAS CITY, MO 64118-4600
(816) 454-0666
(816) 559-7118
Mailing address
15940 COUNTRY LN W, PLATTE CITY, MO 64079-9524
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2018021515
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018021515
MISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS
MO
Enumeration date
07/02/2018
Last updated
05/15/2023
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