Basic Information
Provider Information
NPI: 1740505700
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLOERSCH
FirstName: MISTY
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: ACNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 504407
Address2:  
City: ST. LOUIS
State: MO
PostalCode: 631504407
CountryCode: US
TelephoneNumber: 8165027000
FaxNumber: 8169327957
Practice Location
Address1: 4320 WORNALL RD
Address2: SUITE 710
City: KANSAS CITY
State: MO
PostalCode: 641115941
CountryCode: US
TelephoneNumber: 8169322700
FaxNumber: 8169322705
Other Information
ProviderEnumerationDate: 04/02/2010
LastUpdateDate: 08/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LC0200X2010010566MOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine

No ID Information.


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