Provider Demographics
NPI:1366610537
Name:GRIFFIN, MANDI D (FNP)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:D
Last Name:GRIFFIN
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 1:802 N RIVERSIDE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2553
Mailing Address - Country:US
Mailing Address - Phone:816-271-6666
Mailing Address - Fax:816-271-1300
Practice Address - Street 1:802 N RIVERSIDE RD.,
Practice Address - Street 2:STE. 200
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2553
Practice Address - Country:US
Practice Address - Phone:816-271-6666
Practice Address - Fax:816-271-1300
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200544470BMedicaid
MOP00858875OtherRR MEDICARE
MO428378301Medicaid
MO1366610537Medicaid
F29A00001Medicare PIN
MO701000072Medicare PIN