Provider Demographics
NPI:1396782025
Name:CUNNINGHAM, MARY L (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN
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 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-0771
Practice Address - Fax:573-884-6292
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO071560364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO190040OtherBLUE SHIELD
MO428322101Medicaid
MO467112OtherHEALTHLINK
MO467112OtherHEALTHLINK
Q23209Medicare UPIN
MO821460010Medicare PIN
MO821465236Medicare PIN
MOP00445141Medicare PIN