Provider Demographics
NPI:1760473151
Name:MCMAHON, DORIS A (APMHNP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:A
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:APMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3663
Mailing Address - Country:US
Mailing Address - Phone:816-288-9085
Mailing Address - Fax:417-448-2492
Practice Address - Street 1:800 S ASH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3223
Practice Address - Country:US
Practice Address - Phone:417-448-3690
Practice Address - Fax:417-448-2492
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO050274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427267802Medicaid
MO427267802Medicaid