Organization
EXCELSIOR SPRINGS PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI L BOWMAN (OFFICE MANAGER)
(816) 637-0117
Entity
Organization
Contact information
Practice address
1006 N JESSE JAMES RD, STE 2, EXCELSIOR SPRINGS, MO 64024-1202
(816) 637-0117
(816) 637-0814
Mailing address
1006 N JESSE JAMES RD, STE 2, EXCELSIOR SPRINGS, MO 64024-1202
(816) 637-0117
(816) 637-0814
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R6H00
MO
363LF0000X
Family Nurse Practitioner
2011006205
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202518809
—
MO
Enumeration date
07/13/2011
Last updated
07/13/2011
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