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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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