Provider Demographics
NPI:1992367502
Name:MAUS, KENDRICK R (NP)
Entity Type:Individual
Prefix:
First Name:KENDRICK
Middle Name:R
Last Name:MAUS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N OHIO ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-1609
Mailing Address - Country:US
Mailing Address - Phone:660-476-2111
Mailing Address - Fax:660-476-5591
Practice Address - Street 1:610 N OHIO ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1609
Practice Address - Country:US
Practice Address - Phone:660-476-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019022247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily