ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE
NPI 1962859090
Nurse Practitioner - Family in Saint Joseph, MO

Q: What is Esry Student Health Center Missouri Western State's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since May 18, 2016CLIA 26D0877997 · Waiver

4525 DOWNS DR, BLUM UNION ROOM 203, SAINT JOSEPH, MO 64507(816) 271-4495(816) 271-4496 Get Directions Write a Review

NPPES record last updated: May 18, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Esry Student Health Center Missouri Western State NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE (NPI 1962859090) is a healthcare organization registered as a family in Saint Joseph, Missouri and active in the NPI registry since May 2016. The organization holds a CLIA Waiver certificate valid through March 2, 2028 and lists Elizabeth Roderick, Nurse Practictioner, as its authorized official.

NPPES Registry Identity

NPI1962859090

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameESRY STUDENT HEALTH CENTER MISSOURI WESTERN STATE

Location Address4525 DOWNS DR, BLUM UNION ROOM 203Saint Joseph, MO 64507-2246

Mailing Address4525 Downs Dr, Blum Union Room 203Saint Joseph, MO 64507-2246 · (816) 271-4495 · Fax (816) 271-4496

Phone(816) 271-4495

Fax(816) 271-4496

Organization SubpartNo

Authorized OfficialElizabeth RoderickNurse Practictioner · (816) 271-4495

Enumeration DateMay 18, 2016

✔ NPI 1962859090 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in MO · 138383

4525 DOWNS DR, Saint Joseph, MO 64507

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Other Identifiers 1

Other1801099874MO · Np Type I Npi

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D0877997

Esry Student Health · Saint Joseph, MO

Active · expires Mar 2, 2028

CLIA Number26D0877997

Laboratory TypeSchool/Student Health Service

Certificate Effective DateMarch 3, 2026

Certificate Expiration DateMarch 2, 2028

Laboratory DirectorElizabeth Roderick

Laboratory Phone(816) 271-4495

Laboratory LocationEsry Student Health4525 Downs Drive Blum 203, Saint Joseph, MO 64507

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MISSOURI WESTERN STATE UNIVERSITY

Orthopaedic Surgery