Organization
JOHN KNOX VILLAGE
Active
Other names
JKV Provider Services
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY MCBRIDE (VP - HEALTH & RESIDENT SERVICES)
(816) 347-2030
Entity
Organization
Contact information
Practice address
600 NW PRYOR RD, LEES SUMMIT, MO 64081-1104
(913) 642-4900
(913) 381-0979
Mailing address
PO BOX 25010, OVERLAND PARK, KS 66225-5010
(913) 642-4900
(913) 381-0979
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2011034116
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200674690B
—
KS
01
—
DT2931
RR
MO
Enumeration date
03/27/2013
Last updated
03/27/2013
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