Image Specialties, L.L.C.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

096655 Issued in MO

Legal business name

IMAGE SPECIALTIES, L.L.C.

Practice address

5213 Frederick Ave
Saint Joseph, MO 64506-3263

Phone

(816) 232-6459

Fax

(816) 232-6459

NPI assigned

Aug 1, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theresa R Maxwell, RN, MSN, FNPNPI 1780887109

Title

Owner

Phone

(816) 232-6459

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa Rene Maxwell, RN, MSN, FNP

  • Family Nurse Practitioner
  • Saint Joseph, MO
  • NPI 1780887109
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1629356142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 FREDERICK AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063263",
            "telephone_number": "816-232-6459",
            "fax_number": "816-232-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5213 FREDERICK AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063263",
            "telephone_number": "816-232-6459",
            "fax_number": "816-232-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGE SPECIALTIES, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-01",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-232-6459",
        "authorized_official_credential": "RN, MSN, FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "096655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.