Provider Demographics
NPI:1053947549
Name:EIKERMANN, MARY KATHERINE (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:EIKERMANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:ISMERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 NE ADAMS DAIRY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-5493
Mailing Address - Country:US
Mailing Address - Phone:816-932-4630
Mailing Address - Fax:816-932-4631
Practice Address - Street 1:600 NE ADAMS DAIRY PKWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-5493
Practice Address - Country:US
Practice Address - Phone:816-932-4630
Practice Address - Fax:816-932-4631
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019038327363LA2100X, 363LA2200X
MO2019038328363LF0000X
KS5378984012363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty