Provider Demographics
NPI:1992732556
Name:VAN DUYNE, NICHOLE D (DO)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:D
Last Name:VAN DUYNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:D
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6420 PROSPECT AVE
Mailing Address - Street 2:STE T-303
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-333-1919
Mailing Address - Fax:816-333-2614
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:STE T-303
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-333-1919
Practice Address - Fax:816-333-2614
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008026684207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease