Provider Demographics
NPI:1053601716
Name:PANIAMOGAN, CEPHAS (FNP-C)
Entity type:Individual
Prefix:MR
First Name:CEPHAS
Middle Name:
Last Name:PANIAMOGAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16027 LOCUST ST
Mailing Address - Street 2:APT 5
Mailing Address - City:EAGLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64442-7130
Mailing Address - Country:US
Mailing Address - Phone:660-867-5111
Mailing Address - Fax:660-425-2366
Practice Address - Street 1:3202 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2713
Practice Address - Country:US
Practice Address - Phone:660-425-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011007027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily