Knickerbocker, Phyllis

Knickerbocker, Phyllis is an individual health care provider with primary practice located at 2727 Mcclelland Blvd , Joplin MO 64804-1626. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Knickerbocker, Phyllis can be contacted via phone (417) 781-2727.

Contact Information

Primary practice address
2727 Mcclelland Blvd Joplin MO 64804-1626
Phone: (417) 781-2727
Fax: (316) 652-0340
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 1999137827 Missouri

Profile Details

NPI number 1528035144
LBN Legal business name Knickerbocker, Phyllis
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 2nd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528035144 NPPES
Missouri Other 108602A BCBS

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