Individual
DR. STACY L. KANAGAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
940 W MOUNT VERNON ST, SUITE 220, NIXA, MO 65714-9609
(417) 724-5437
(417) 724-5433
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2002009355
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168192003
—
AR
05
—
208341206
—
MO
Enumeration date
06/21/2006
Last updated
05/13/2013
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