Provider Demographics
NPI:1851456735
Name:MOLLEKER, ELIZABETH ANN (NP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:MOLLEKER
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:2330 E MEYER BLVD
Mailing Address - Street 2:T-207
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1132
Mailing Address - Country:US
Mailing Address - Phone:816-276-9100
Mailing Address - Fax:816-276-9101
Practice Address - Street 1:2330 E MEYER BLVD
Practice Address - Street 2:T-207
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1132
Practice Address - Country:US
Practice Address - Phone:816-276-9100
Practice Address - Fax:816-276-9101
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS14-94030-052163W00000X
KS45930363L00000X
MO2002022317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200542810BMedicaid
MO1851456735Medicaid
KS200542810BMedicaid
MOT41000004Medicare PIN