Provider Demographics
NPI:1871566646
Name:NEUSCHAFER, DARIC TODD (PA-C)
Entity type:Individual
Prefix:
First Name:DARIC
Middle Name:TODD
Last Name:NEUSCHAFER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PRAIRIE COURT
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060
Mailing Address - Country:US
Mailing Address - Phone:620-669-2500
Mailing Address - Fax:
Practice Address - Street 1:2525 GLENN HENDREN DRIVE SUITE 204
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:620-669-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00932363A00000X
MO2020000890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200005140AMedicaid
Q05099Medicare UPIN