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NPI Code Detail

MEDICARE: MARY M BRANT FPMHNP

MEDICARE: MARY M BRANT FPMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2021028550MO
2103TC0700XClinical Psychologist2007000444MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356407720
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY M BRANT FPMHNP
Provider Business Mailing Address
First Line : PO BOX 844715
Second Line :
City : KANSAS CITY
State : MO
Zip : 64184-4715
Country : US
Telephone Number : 417-761-5214
Fax Number : 417-761-5065
Provider Business Practice Location Address
First Line : 17844 E 23RD ST S
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64057-1840
Country : US
Telephone Number : 816-254-3652
Fax Number : 816-254-9243
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 05/20/2026

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