Individual
SANDRA L MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
19550 E 39TH ST S, SUITE 245, INDEPENDENCE, MO 64057-2358
(816) 373-0655
(816) 478-6374
Mailing address
19550 E 39TH ST S, SUITE 245, INDEPENDENCE, MO 64057-2358
(816) 373-0655
(816) 478-6374
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
069917
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010568509
—
MO
05
—
200608400A
—
KS
01
—
34655011
BCBS
—
01
—
34655021
BCBS
—
01
—
34655041
BCBS
—
05
—
427629407
—
MO
05
—
540568508
—
MO
05
—
595956103
—
MO
05
—
595956202
—
MO
05
—
595956400
—
MO
05
—
595985805
—
MO
05
—
599225901
—
MO
Enumeration date
04/17/2006
Last updated
01/21/2022
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