Esry Student Health Center Missouri Western State

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

138383 Issued in MO

Legal business name

ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE

Practice address

4525 Downs Dr
Blum Union Room 203
Saint Joseph, MO 64507-2246

Phone

(816) 271-4495

Fax

(816) 271-4496

NPI assigned

May 18, 2016

Organization subpart

No

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

Authorized official

Name

Elizabeth Roderick, FNP

Title

Nurse Practictioner

Phone

(816) 271-4495

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1962859090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 DOWNS DR",
            "address_2": "BLUM UNION ROOM 203",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072246",
            "telephone_number": "816-271-4495",
            "fax_number": "816-271-4496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 DOWNS DR",
            "address_2": "BLUM UNION ROOM 203",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072246",
            "telephone_number": "816-271-4495",
            "fax_number": "816-271-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "NURSE PRACTICTIONER",
        "authorized_official_telephone_number": "816-271-4495",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "138383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP TYPE I NPI",
            "identifier": "1801099874",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darla Denise Enzbrenner, PTA
• Paul R Epp, MD
• Tayler Epperson
• Eric G Sollars, MD
• Kate Lee Esely, ATC
• Joyce E. Estes, LCSW
• Andrew Linus Euler, DDS
• Evans Pediatric Clinic PC
• Aaron Evans
• Ashley M Evans, LPC

• 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 May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.