Basic Information
| Provider Information | |||||||||
| NPI: | 1669843793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOCK | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 S BUSINESS HIGHWAY 13 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640671515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602592440 | ||||||||
| FaxNumber: | 6602510524 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 MISSOURI ST | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6604932262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2016006905 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.