Provider Demographics
NPI:1598262305
Name:SQUIRES, DEVIN (FNP)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:SQUIRES
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: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 1:500 N KEENE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8105
Practice Address - Country:US
Practice Address - Phone:573-817-3165
Practice Address - Fax:573-875-9260
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018021731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420058702Medicaid