Provider Demographics
NPI:1639480445
Name:CLINE, MARTIN L (ANP-BC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:CLINE
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 CANTERBURY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2386
Mailing Address - Country:US
Mailing Address - Phone:785-625-4699
Mailing Address - Fax:785-261-7424
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2386
Practice Address - Country:US
Practice Address - Phone:785-625-4699
Practice Address - Fax:785-261-7424
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017622363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639480445Medicaid
MO1639480445Medicaid