Provider Demographics
NPI:1336156090
Name:GASPAROVIC, NANCY KAY (DPM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KAY
Last Name:GASPAROVIC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 EAST PLATTE CLAY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429
Mailing Address - Country:US
Mailing Address - Phone:816-632-5228
Mailing Address - Fax:816-632-5229
Practice Address - Street 1:609 EAST PLATTE CLAY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429
Practice Address - Country:US
Practice Address - Phone:816-632-5228
Practice Address - Fax:816-632-5229
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO795213E00000X
KS12000295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
25093027OtherBCBS
MO303806103Medicaid
MO1104832872Medicaid
U70957Medicare UPIN
L99B706Medicare PIN