Provider Demographics
NPI:1699109033
Name:PLATZ, CECILEE W (AA -C)
Entity type:Individual
Prefix:
First Name:CECILEE
Middle Name:W
Last Name:PLATZ
Suffix:
Gender:F
Credentials:AA -C
Other - Prefix:
Other - First Name:CECILEE
Other - Middle Name:W
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA-C
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:901 E 104TH ST
Practice Address - Street 2:MAILSTOP 400N
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4517
Practice Address - Country:US
Practice Address - Phone:816-502-8756
Practice Address - Fax:816-932-9670
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013027462367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1699109033Medicaid
MO431560263OtherTRICARE
MOP01241135OtherRR MCR
MO132680446Medicare PIN
MO431560263OtherTRICARE