Provider Demographics
NPI:1689664690
Name:ENDICOTT, RENEE (FNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ENDICOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-0092
Mailing Address - Country:US
Mailing Address - Phone:816-590-4907
Mailing Address - Fax:
Practice Address - Street 1:2464 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2718
Practice Address - Country:US
Practice Address - Phone:816-590-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO094920363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427007901Medicaid
MOK448441Medicare PIN
MOS57636Medicare UPIN