MCCORMICK, SANDRA L (FNP)

Provider Demographics

• NPI: 1942264718
• Name: MCCORMICK, SANDRA L (FNP)
• Entity Type: Individual
• First Name: SANDRA
• Middle Name: L
• Last Name: MCCORMICK
• Gender: F
• Credentials: FNP
• Other - First Name: SANDRA
• Other - Middle Name: L
• Other - Last Name: POTTER
• Other - Last Name Type: Former Name
• Mailing Address - Street 1: 19550 E 39TH ST S
• Mailing Address - Street 2: SUITE 245
• Mailing Address - City: INDEPENDENCE
• Mailing Address - State: MO
• Mailing Address - Zip Code: 64057-2358
• Mailing Address - Country: US
• Mailing Address - Phone: 816-373-0655
• Mailing Address - Fax: 816-478-6374
• Practice Address - Street 1: 19550 E 39TH ST S
• Practice Address - Street 2: SUITE 245
• Practice Address - City: INDEPENDENCE
• Practice Address - State: MO
• Practice Address - Zip Code: 64057-2358
• Practice Address - Country: US
• Practice Address - Phone: 816-373-0655
• Practice Address - Fax: 816-478-6374
• Is Sole Proprietor?: No
• Enumeration Date: 2006-04-17
• Last Update Date: 2022-01-21

Provider Licenses

State	License ID	Taxonomies
MO	069917	363LF0000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MO	595956202	Medicaid
MO	010568509	Medicaid
KS	200608400A	Medicaid
	34655011	Other	BCBS
MO	540568508	Medicaid
MO	595985805	Medicaid
MO	427629407	Medicaid
MO	595956103	Medicaid
	34655021	Other	BCBS
	34655041	Other	BCBS
MO	599225901	Medicaid
MO	595956400	Medicaid
	P270000	Medicare PIN
MO	427629407	Medicaid
	268550	Medicare Oscar/Certification
MO	X85000002	Medicare PIN
MO	P00731941	Medicare UPIN
	Q28732	Medicare UPIN
KS	200608400A	Medicaid
MO	595956400	Medicaid
	34655041	Other	BCBS
MO	599225901	Medicaid
MO	595985805	Medicaid