Provider Demographics
NPI:1154979938
Name:TESTERMAN, GREG L (ANP)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:L
Last Name:TESTERMAN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4200 LITTLE BLUE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057
Mailing Address - Country:US
Mailing Address - Phone:816-353-2700
Mailing Address - Fax:816-795-7311
Practice Address - Street 1:4200 LITTLE BLUE PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057
Practice Address - Country:US
Practice Address - Phone:816-353-2700
Practice Address - Fax:816-795-7311
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2020-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2004024273163WG0000X, 363LA2200X
MO2019032538363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice